Maxillary reconstruction: Current concepts and controversies

Abstract

Maxillary reconstruction is still an evolving art when compared to the reconstruction of the mandible. The defects of maxilla apart from affecting the functions of the speech, swallowing and mastication also cause cosmetic disfigurement. Rehabilitation of the form and function in patients with maxillary defects is either by using an obturator prosthesis or by a surgical reconstruction. Literature is abundant with a variety of reconstructive methods. The classification systems are also varied, with no universal acceptance of any one of them. The oncologic safety of these procedures is still debated, and conclusive evidence in this regard has not emerged yet. Management of the orbit is also not yet addressed properly. Tissue engineering, that has been hyped to be one of the possible solutions for this vexing reconstructive problem, has not come out with reliable and reproducible results so far. This review article discusses the rationale and oncological safety of the reconstructing the maxillary defects, critically analyzes the classification systems, offers the different reconstructive methods and touches upon the controversies in this subject. The management of the retained and exenterated orbit associated with maxillectomy is reviewed. The surgical morbidity, complications and the recent advances in this field are also looked into. An algorithm, based on our experience, is presented.

Unusually large-sized peripheral ossifying fibroma

“…The reconstruction options available for such maxillary defects could vary from simple prosthesis to using locoregional flaps such as temporalis muscle and fascia along with buccal fat pad or skin graft or to distant flaps such as anterolateral thigh free flap or free fibula flaps, followed by dental rehabilitation using implants. [19] Booth suggested smaller margins than the 1 cm margin that is required for ameloblastoma, odontogenic myxoma, or calcifying epithelial odontogenic tumor. [20]…”

Microsurgical reconstruction of the facial skeleton in the treatment of malignant tumors of the head and neck

“…Для устранения дефектов верхней челюсти используют обтураторы, местно-перемещенные мягкотканные лоскуты или с включением костного компонента, перемещенные и свободные аутотрансплантаты, комбинацию мягких тканей и аллопластических имплантатов [15].…”

Recent advances in head and neck cancer reconstruction

“…Reconstructions are individual, or institute based. [10] Browns classification is simple and sound in its principle during planning reconstruction [ Figure 1]. [11] Maxillary defect must be assessed in horizontal and vertical dimensions.…”