Current strategies in reconstruction of maxillectomy defects. Maxillectomy is a surgical procedure performed to remove all or part of the maxilla bone as a treatment for tumor of maxillary sinus. Secure surgical prosthesis modify previouslyfabricated surgical obturator if prosthesis is not made, may use 4 x 4 gauze soaked in bacitracin ointment to obturate defect. This allows for full access to the maxillary sinus, including the. A maxillectomy is a surgical procedure used to treat oral cavity cancer and cancers affecting the jaw and sinus cavity. It is widely assumed that free flaps as a reconstructive method for the maxillectomy defect patient lead to improved. This article describes a simple technique to fabricate a surgical obturator that restores patients original dentition and facial and palatal tissue form. In the past 25 years, head and neck surgery has subjected to rapid progression in surgical technique and technology that has led to respectability of larger and more extensive cancers tumors of the head and neck region and led to a larger number of patients with extensive post surgical defects and subsequent physiological consequences that, without the field of. Extended external medial maxillectomy for the management of a. The technique involves the use of a zygomatic oncology implant perforated microvascular soft tissue flap zip flap. The obturator prosthetic maxillectomy will nickson. N2 the surgical treatment of sinonasal tumors is constantly evolving. Written by peterjohn wormald, the richly illustrated text details anatomy and operative treatment of sinonasal.
New technique to fabricate an immediate surgical obturator restoring the defect in original anatomical form. For treatment of a sinonasal inverted papilloma ip, it is essential to have a definite diagnosis, to identify its origin by computed tomography ct and magnetic resonance imaging mri, and to select the appropriate surgical approach based on the staging system proposed by krouse. Endoscopic modified medial maxillectomy for resection of an. Commonly, multiple skin paddle reconstruction is required for such cases to recreate palatal or external skin defects. Reconstruction with the fibula osteocutaneous free flap figure 25. Various incisions and extensions to the skull base, infratemporal fossa, and orbit have been described. Superb diagrams and descriptions of commmon surgical procedures. This classic reference is a musthave for otolaryngologisthead and neck surgeons, as well as residents and fellows seeking a robust tutorial on the latest functional endoscopic sinus surgery fess techniques. The classic weberfergusson incision with sublabial degloving has been the gold standard in the surgical management of maxillary sinus carcinoma.
This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid postoperative prosthodontic rehabilitation with a fixed dental prosthesis following lowlevel maxillectomy for malignant disease. A partial maxillectomy is a surgical procedure your veterinarian may perform if disease or damage is present on your dogs upper jaw. A maxillectomy is the partial removal of the upper jaw bone. Bilateral rostral maxillectomy is a surgical procedure involving removal of the maxilla rostral to the second premolar tooth. The prosthetic rehabilitation of the maxillectomy defect is important to restore oral functions and facial contours as well as to improve patients healthrelated quality of life hrqol. Atlas of surgical techniques hardcover january 15, 1996. Partial maxillectomy in dogs procedure, efficacy, recovery. The fully updated comprehensive anatomical guide on surgery of the paranasal sinuses and skull base. Inferior turb maxillectomy is potentially complicated by injuries to the orbital contents, lacrimal apparatus, optic nerve, ethmoidal arteries. The immediate postoperative restoration of form and function shortens recovery time in the hospital and expedites the patients return to the community. Use of paramedian mandibulotomy combined with sublabial incision obviates additional facial incisions as described by tiwari. Patients may be on 4b or rarely the intensive care unit 5d. It enables 3d understanding of diseased anatomy, associated surgical treatment decision making, and safer surgery. This classification system provides a reconstructive algorithm to guide the reconstructive surgeon, which is useful in the decisionmaking process.
As in the acclaimed prior editions, endoscopic sinus surgery, fourth edition focuses strictly on anatomy, 3d reconstruction, and stepbystep surgical techniques. Rapid advances which took place in the field of anesthesia and surgical techniques in 1950 rekindled the interest in total maxillectomy as a. Jun 03, 2016 the maxillectomy was designed for the surgical treatment of tumors involving the maxilla, as well as the maxillary sinus. It will also serve as a valuable refresher for established practitioners preparing for surgery. A maxillectomy is the surgical removal or resection of the maxilla or upper jaw bone.
Current strategies in reconstruction of maxillectomy. Rapid advances which took place in the field of anesthesia and surgical techniques in 1950 rekindled the interest in total maxillectomy as a viable treatment. Maxilla resection an overview sciencedirect topics. Often patients may require artificial maxillary obturator prosthesis to help them recover from. Maxillectomy and craniofacial resection slideshare. Jun 30, 2011 the maxillofacial prosthodontist, as a member of the surgical team, is able to aid in the recovery and rehabilitation of the maxillectomy patient by fabricating and placing a surgical obturator. In a retrospective survey of 27 owners of dogs that had undergone mandibulectomy or maxillectomy at a mean of 44 months previously, 85% of owners of owners stated that they were satisfied with their decision to have surgery performed. The present study analyzed all patients receiving endoscopicassisted maxillectomy eam at two tertiarycare referral centers during the last decade, mainly focusing on the control of the posterior and medial resection margins.
Lesions of the medial maxillary wall were traditionally approached through an external approach, usually a lateral rhinotomy. This chapter will only deal with the open surgical medial maxillectomy technique. After an overview of embryology, surgical anatomy, and imaging. Class 2 low maxillectomy not including orbital floor or contents class 3 high maxillectomy involving orbital contents class 4 radical maxillectomy includes orbital exenteration classes 2 to 4 are qualified by adding the letter a, b, or c. A simple technique to fabricate a surgical obturator restoring the defect in original anatomical form. The surgery may be extended to include orbital exente. Maxillectomy bone cuts and classification surgical videos dr rajnish talwar duration.
Surgical techniques in otolaryngology head and neck. A hollow definitive obturator fabrication technique for. The obturator sounds like a film title from the latin. The indications of medial maxillectomy are not only restricted for inverted papilloma but can be. Each specimen is different, so consult with the attending pathologist regarding the best way to approach the specimen and how margins should be submitted perpendicular vs. A hollow definitive obturator fabrication technique for management of partial maxillectomy j adv prosthodont 2012. The horizontal or palatal component is classified as follows. Resection includes the floor and medial wall of the orbit and the ethmoid sinuses. The procedure may create a connection between the nose, sinus and oral cavities which can make speech and swallowing challenging. Stage t1 and t2 were selected for the above mentioned surgical approach of total maxillectomy. It was during this period that weber ferguson came out with his epoch making lateral rhinotomy incision which caused very little cosmetic deformity.
Anatomy, threedimensional reconstruction, and surgical technique. The catheter will be removed when the patient is up. Written by peterjohn wormald, the richly illustrated text details anatomy and operative treatment of sinonasal conditions such as. Current concepts and novel techniques in the prosthodontic. Oriented toward general surgery, it includes advanced operations which a general surgeon may unexpectedly need to do, such as a ruptured aneurism or embolectomy. Total maxillectomy refers to surgical resection of. Lazars attempted the first maxillectomy in 1827, but the procedure was aborted because of excessive blood loss. Maxillectomy maxillectomy is a surgical procedure used to partially or. The level of the floor of the anterior cranial fossa fovea ethmoidalis and cribriform plate corresponds with an. An essential guide to basic and advanced procedures this handbook presents a comprehensive overview of the fundamental concepts and core techniques for basic and advanced otolaryngologic procedures. Click the section headings in blue to expand or collapse the content. Still, as with any surgical procedure, there is always risk of an infection after the surgery. A surgical notebook is ideal for residents and medical students in otolaryngology, head and neck surgery, and facial plastic surgery.
I have never worn a brace or had any false teeth, so i had no personal reference. Recently, a new surgical approach named endoscopic modified medial maxillectomy emmm was proposed. Anatomical, histological, and pathological considerations the right. Patient had seen by few ent surgeons for the management of severe nasal. The technique involves the use of a zygomatic oncology implant perforated. An algorithm for maxillectomy defect reconstruction.
Sep 24, 2019 the surgical technique of a total or complete maxillectomy has remained relatively unchanged over the past 60 years. Jan 26, 2017 an advanced technique used for the management of recalcitrant chronic maxillary sinusitis and certain maxillary sinus tumors e. External medial maxillectomy is a common surgical approach for the management. The patient will have a foley catheter to drain your bladder in place after surgery.
Maxillectomy medical definition merriamwebster medical. Written by peterjohn wormald, the richly illustrated text details anatomy and operative treatment of sinonasal conditions such as nasal polyposis, chronic rhinosinusitis crs, samters triad, eosinophilic. Click read more for condition details, which is that this book is from a bookstore that didnt sell it. A simple technique to fabricate a surgical obturator. Department of pathology department of pathology the johns hopkins university the johns hopkins university school of medicine school of medicine baltimore, maryland baltimore, maryland timothy h. The obturator prostheses for maxillectomy meenakshi a. Case report a fortynine year old man was surgically operated for the squamous cell carcinoma of a left maxilla and was referred for the prosthodontic rehabilitation. Preoperative imaging and surgical margins in maxillectomy. The term head and neck cancer hnc refers to a group of tumours that arise in five primary sites oral cavity, pharynx, salivary glands, paranasal sinuses and larynx.
Maxillectomy definition of maxillectomy by medical. Chapters contain material on maxillectomy, radical neck dissection, mastectomy, the esophagus, stomach, biliary system, pancreas, colon, uterus and adnexia, and much more. The obturator prostheses for maxillectomy a meenakshi, darshan shah department of prosthodontics, tamil nadu government dental college and hospital, chennai, india. Surgical pathology dissection an illustrated guide second edition william h. Several incisions have been used to facilitate the variety of surgical procedures encompassed by the term maxillectomy. Transnasal endoscopic medial maxillectomy as the initial.
Endoscopic modified medial maxillectomy for resection of. Pdf the concept of maxillectomy was first described by lazars in 1826. A total maxillectomy is the resection of the entire maxilla, whereas a limited maxillectomy is only a partial resection, involving the removal of only the medial wall or the floor of the maxillary sinus. Total maxillectomy and orbital exenteration vula university of. Lead author, steven economou, md, was chief of surgery at rushpresbyterian st.
This technique is indicated for benign oral tumors, such as acanthomatous ameloblastoma and either small or lowgrade malignant tumors, which have crossed the midline. That is, this is a brand new book that has never been sold, read or used, but note. May 24, 2019 the term head and neck cancer hnc refers to a group of tumours that arise in five primary sites oral cavity, pharynx, salivary glands, paranasal sinuses and larynx. Maxillectomy is necessary for the surgical management of a variety of malignant as well as. The woodruff screw technique is now obsolete and mentioned primarily for historical purposes.
Preprosthetic surgical alterations in maxillectomy to. There are no restrictions, and colleagues are welcome to use, copy and quote as they wish. Anatomical, histological, and pathological considerations the right and left maxillae are paired bones forming the midface. The difference in surgical technique was the division of the medial pterygoid muscle, which was stripped at the point of. Tumors of the maxillary sinus and adjacent anatomic sites require maxillectomy. Jul 29, 2017 this aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid postoperative prosthodontic rehabilitation with a fixed dental prosthesis following lowlevel maxillectomy for malignant disease. Recently, a new surgical approach named endoscopic modified medial maxillectomy emmm. The different types of incisions are based on three fundamental but competing principles of exposure, function, and cosmetic outcome. The maxillectomy was designed for the surgical treatment of tumors involving the maxilla, as well as the maxillary sinus. This volume is a highly illustrated atlas covering commonly performed ablative head and neck procedures procedures involving the removal of tissue, both open and endoscopic. This userfriendly reference and accompanying dvds, authored by a team of internationally recognized experts, present the latest treatment options for the maxillary sinus, including a detailed analysis of the effectiveness of different surgical techniques and how best to successfully apply them. Medial maxillectomy is the procedure designed to en bloc resect the party wall between the nasal cavity, maxillary antrum, and adjacent ethoid labyrinth along with the tumor within the nose and sinus.
An advanced technique used for the management of recalcitrant chronic maxillary sinusitis and certain maxillary sinus tumors e. After an overview of embryology, surgical anatomy, and imaging, concise chapters guide the reader. These should be used as dictated by the patients needs and tumor extent. Filled with over 300 detailed illustrations, this surgical atlas covers operative techniques and addresses major intraoperative pitfalls. Anatomical figures clear and done from a surgeons perspective. Surgical reconstruction should meet the objectives outlined by hoopes and edgerton. Maxillectomy definition of maxillectomy by medical dictionary. Largevolume maxillectomy defects with or without orbital exenteration brown class 3 or 4a, 4b, 4c, or 4d or cordeiro types 3b and 4 typically require microvascular reconstruction. Maxillectomy is the surgical excision of all or part of the maxilla upper jaw bone. Maxillectomy involves the removal of the bone and tissue in your dogs upper jaw. Zender, mdb from the a department of otolaryngology, head and neck surgery, loyola university medical center, m slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. In the past 25 years, head and neck surgery has subjected to rapid progression in surgical technique and technology that has led to respectability of larger and more extensive cancers tumors of the head and neck region and led to a larger number of patients with extensive post surgical defects and subsequent physiological consequences that, without the field of maxillofacial.
Healthrelated quality of life in maxillectomy patients. Open and endoscopic medial maxillectomy for maxillary tumors a. Maxillectomy through mandibulotomya retrospective clinical. This might require antibiotics andor drainage of the infection.
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