Alternativas reconstructivas post maxilectomía por enfermedad neoplásica

Abstract

Background: The reconstruction of midfacial defects is a major challenge. The maxillary bones are the more important of the facial skeleton, provide support between skull base and maxillary arches, separate cavities and are involved in swallowing, phonation, mastication, vision and appearance. The maxillectomy involves varying degrees of functional impairment. The maxillary reconstruction ranges from the use of obturator prosthesis, local flaps to free flaps. Aim: To present the different reconstructive alternatives used after a maxillectomy for oncologic disease in our hospital. Patients and Methods: Retrospective analysis of all patients that was submitted to a maxillectomy for oncologic disease between 2008 and 2011 in our center. Results: The series consisted of 12 patients, 8 women and median age 57 years (range, 25-84). We realized Type IIA maxillectomy in five patients, IIB to two patients, IIIA to four patients and IIIB to one patient. We achieved R0 in all cases. The reconstruction was realized with obturator prosthesis in four patients, three patients with pedicled flaps and five patients were reconstructed with free flaps. All patients obtain an adequate functional status. One patient has partial flap loss. Discussion: Is recommended adjust the surgical choice to the patient prognosis. The obturator prosthesis is a good choice for selected group. The temporal muscle flap presents adequate functional results and is recommended in advanced disease and poor prognosis. The microsurgical reconstruction is the best choice with better functional and aesthetics outcomes in type II, III and IV maxillectomy.