Reconstruction post oncologic maxillectomy. IPRAS

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Reconstruction post oncologic maxillectomy. IPRAS

  1. 1. RECONSTRUCTION POST ONCOLOGIC MAXILLECTOMY Ricardo Yáñez MD, Francisco J. Loyola MD, Diego Alcocer DDS and Jorge Cornejo M.D Dr. Sotero del Río Hospital Chile IPRAS 2013
  2. 2. Background • The midfacial defects reconstructions for oncologic resections are a surgical challenge Mc Carthy C, Cordeiro P et al. Plast. Reconstr. Surg. 2010; 126:1947-59 IPRAS 2013
  3. 3. Background • The maxillar provide the structural support between skull base and maxillary arches. • To separate oral and nasal cavities. • To participate in swallowing, phonation, mastication, vision and aesthetic appearance. IPRAS 2013
  4. 4. Background • Generally we need to realize the maxillectomy associated with soft tissue resection. • This results in different functional impairments • The maxillary reconstruction going from obturator prosthesis, local flaps to free flaps. Algorithm and Outcomes: 15-year Review of Midface Reconstruction. Plast. Reconstr. Surg. 2011. In press IPRAS 2013
  5. 5. Aim • To present the different reconstructives alternatives used after a maxillectomy for oncologic disease in our hospital. IPRAS 2013
  6. 6. Maxillectomy classification Type I Type II IPRAS 2013
  7. 7. Maxillectomy classification Type III A Type IIIB IPRAS 2013
  8. 8. Maxillectomy classification Type IV IPRAS 2013
  9. 9. Method • Retrospective analysis of all patients that was submitted to a maxillectomy for oncologic disease between 2008 and 2011 in our center • Medical record review. • Clinical control IPRAS 2013
  10. 10. Method • Complications • Perioperative < 30 days after surgery • Late > 30 days after surgery IPRAS 2013
  11. 11. ResultsPatients characteristics n=12 Age (median and range) 57 years range 25 - 84 years Gender female : male 8:4 Smoking 8 75% Alcoholism 5 41.6% Consultation reason Bulking/pain Dental derivation 5 7 41.6% 58.4% TNM Stage IV 12 100% Characteristics of the patients with a maxillectomy for oncologic disease IPRAS 2013
  12. 12. Results Pathologic diagnosis n % Squamous cell 6 50% Melanoma 2 16.7% Sarcoma 2 16.7% Adenoid cystic carcinoma 1 8.3% Basal - cell carcinoma 1 8.3% Porcentual distribution by pathologic diagnosis IPRAS 2013
  13. 13. Results Maxillectomy Total Obturator prosthesis Temporalis muscle flap* Radial forearm flap** Latissimus dorsi flap** I 3 3 - - - IIA 2 1 - 1 - IIB 2 - - 2 - IIIA 4 - 3 - 1 IIIB 1 - - - 1 IV - - - - - Total 12 4 3 3 2 * Local Flap / **Free flap Distribution by Maxillectomy and realized reconstruction IPRAS 2013
  14. 14. Maxillar, nasal and palate cancer – Maxillectomy IIA – Obturator prosthesis
  15. 15. Maxillar, nasal and palate cancer – Maxillectomy IIA – Obturator prosthesis
  16. 16. Palate cancer– Maxillectomy IIB – Radial flap
  17. 17. Left Maxillary sinus cancer – Maxillectomy IIB – Radial flap
  18. 18. Maxillary sinus cancer– Maxyllectomy IIIA – Latissimus dorsi flap
  19. 19. Maxillary sinus cancer – Maxillectomy IIIA – Latissimus dorsi flap
  20. 20. Adenid Cystic Cancer of Maxillary sinus - Maxillectomy IIIA - Temporalis flap
  21. 21. Adenid Cystic Cancer of Maxillary sinus - Maxillectomy IIIA - Temporalis flap
  22. 22. Maxillary cancer - Maxillectomy IIIA - Temporalis flap
  23. 23. Basal Cell skin cancer/maxillary compromise - Maxillectomy IIIB - Latissimus dorsi
  24. 24. Results • In all patients we achieve a satisfactory functional outcome • Complications • Aspirative pneumonia in two patients. • Partial necrosis of latissimus dorsi flap • venous thrombosis IPRAS 2013
  25. 25. Discussion • Is recommended to adjust the reconstructive choice to • Maxillectomy realized • Age • TNM • Comorbidities • Functional outcomes IPRAS 2013
  26. 26. Discussion • The obturator prosthesis can be reserve for selected patients with limited palatal defects. IPRAS 2013
  27. 27. Discussion • The unilateral or bilateral temporalis muscle flap is recommended and presents adequate functional outcome in patients with advanced disease and poor prognosis. IPRAS 2013
  28. 28. Discussion • The microsurgical reconstruction is the surgical alternative of choice, with the best funcional and aesthetics outcomes in patients with type II - III - IV maxillectomies IPRAS 2013
  29. 29. RECONSTRUCTION POST ONCOLOGIC MAXILLECTOMY Ricardo Yáñez MD, Francisco J. Loyola MD, Diego Alcocer DDS and Jorge Cornejo M.D Dr. Sotero del Río Hospital Chile IPRAS 2013

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