reconstruction post oncologic maxillectomy. ipras
TRANSCRIPT
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RECONSTRUCTION POST
ONCOLOGIC MAXILLECTOMY
Ricardo Yáñez MD, Francisco J. Loyola MD, Diego Alcocer DDS and Jorge Cornejo M.D
Dr. Sotero del Río HospitalChile
IPRAS 2013
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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
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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.
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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
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Aim
•To present the different
reconstructives alternatives
used after a maxillectomy for
oncologic disease in our
hospital.
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Maxillectomy classification
Type I
Type II
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Maxillectomy classification
Type III A
Type IIIB
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Maxillectomy classification
Type IV
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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
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Method
•Complications
•Perioperative < 30 days after
surgery
•Late > 30 days after surgery
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ResultsPatients
characteristics n=12
Age (median and
range)57 years range 25 - 84 years
Genderfemale : male
8:4
Smoking 8 75%
Alcoholism 5 41.6%
Consultation reason
Bulking/painDental
derivation
57 41.6%
58.4%
TNMStage IV
12 100%
Characteristics of the patients with a maxillectomy for oncologic disease
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ResultsPathologic 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
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ResultsMaxillectomy 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
flapDistribution by Maxillectomy and realized reconstruction
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Maxillar, nasal and palate cancer – Maxillectomy IIA – Obturator prosthesis
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Maxillar, nasal and palate cancer – Maxillectomy IIA – Obturator prosthesis
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Palate cancer– Maxillectomy IIB – Radial flap
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Left Maxillary sinus cancer – Maxillectomy IIB – Radial flap
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Maxillary sinus cancer– Maxyllectomy IIIA – Latissimus dorsi flap
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Maxillary sinus cancer – Maxillectomy IIIA – Latissimus dorsi flap
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Adenid Cystic Cancer of Maxillary sinus - Maxillectomy IIIA - Temporalis flap
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Adenid Cystic Cancer of Maxillary sinus - Maxillectomy IIIA - Temporalis flap
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Maxillary cancer - Maxillectomy IIIA - Temporalis flap
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Basal Cell skin cancer/maxillary compromise - Maxillectomy IIIB - Latissimus dorsi
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Results•In all patients we achieve a
satisfactory functional outcome
•Complications
•Aspirative pneumonia in two patients.
•Partial necrosis of latissimus dorsi flap
•venous thrombosis
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Discussion•Is recommended to adjust the
reconstructive choice to
•Maxillectomy realized
•Age
•TNM
•Comorbidities
•Functional outcomes
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Discussion
•The obturator prosthesis can
be reserve for selected
patients with limited palatal
defects.
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Discussion
•The unilateral or bilateral
temporalis muscle flap is
recommended and presents
adequate functional outcome in
patients with advanced disease
and poor prognosis.
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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
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RECONSTRUCTION POST
ONCOLOGIC MAXILLECTOMY
Ricardo Yáñez MD, Francisco J. Loyola MD, Diego Alcocer DDS and Jorge Cornejo M.D
Dr. Sotero del Río HospitalChile
IPRAS 2013