Soft tissue reconstruction with anterior pedicled inferior turbinate flap in conjunction with palatal flap for standard inferior maxillectomy with hard palate resection

Infrastructure maxillectomy for maxillary sinus and hard palate neoplasms

Infrastructure maxillectomy is a surgical procedure to remove the lower part of the maxilla and hard palate. The objective of the present study was to analyze clinical data and treatment outcome of patients who underwent infrastructure maxillectomy between 2011 and 2019. A total of 13 patients who underwent infrastructure maxillectomy for maxillary sinus and hard palate neoplasms between 2011 and 2019 were analyzed. These patients were subdivided into maxillary sinus neoplasm (n=5) and hard palate neoplasm (n=8) groups. All patients except one underwent infrastructure maxillectomy using the sublabial approach. One patient underwent an external approach through lateral rhinotomy. Postoperative reconstruction was performed for 11 patients using obturator, 6 patients using skin grafts and 3 patients using free flaps. A total of 6 patients had radiotherapy (RT), 3 had concurrent chemoradiotherapy (CCRT) and 2 had chemotherapy after surgery. The survival rate and recurrence rate were 61.5% (8/13) and 46.2% (6/13), respectively. The current results suggested that infrastructure maxillectomy may be an effective treatment for maxillary sinus neoplasms in the lower part of the maxillary sinus and hard palate neoplasms without causing marked functional or cosmetic morbidity. Postoperative RT or CCRT may be recommended to decrease the recurrence after infrastructure maxillectomy.

Mucosal resurfacing of the suprastructure maxillectomy cavity using nasal cavity mucosa flaps

OBJECTIVE

We analyzed clinical data of patients in which the suprastructure maxillectomy site was covered with nasal cavity mucosa flaps with or without free mucosa graft from the nasal septum, to determine the usefulness of this procedure.

PATIENTS AND METHODS

A total of four edentulous patients who had the suprastructure maxillectomy site covered using nasal cavity mucosa flaps with or without free mucosa graft from the nasal septum between 2014 and 2020, were analyzed.

RESULTS

All patients underwent suprastructure maxillectomy using the external approach. There were no major complications resulting from surgical intervention. Radiotherapy (RT) was performed in all patients after surgery. All nasal cavity mucosa flaps survived after RT. There was mild cheek retraction, but to a degree that was cosmetically tolerable in all patients. Local recurrence and distant metastasis to the orbit occurred in one patient. Among four patients, two patients died during follow-up, including one tumor related death and one death from old age.

CONCLUSION

We demonstrated that the use of nasal cavity mucosal flap to cover the suprastructure maxillectomy cavity was effective in improving the patient's quality of life by minimizing wound problems and facial contour changes such as cheek retraction despite postoperative RT.

Palatal flap in bilateral inferior partial maxillectomy

Maxillectomy is done for a variety of disease conditions. Reconstruction following maxillectomy is done to restore the form and function. One of the important goals that are to be achieved in reconstruction is the separation of the oral and nasal cavities. In this article, we report the use of palatal flap by preserving the descending palatine artery during bilateral inferior partial maxillectomy, for separating the nasal cavity from the oral cavity. This technique eliminates the need for an obturator or another free or local flap for this purpose.