Type of maxillectomy and approaches of access скачать в хорошем качестве

Type of maxillectomy and approaches of access

Maxillectomy is a surgical procedure involving the removal of part or all of the maxilla to treat various conditions, primarily malignant and benign tumors of the maxilla and adjacent structures. I. Overview of Maxillectomy: • Definition: Maxillectomy involves resection of the maxillary bone, often including adjacent soft tissues, to remove tumors or other pathological conditions. • Indications: • Malignant Tumors: Such as squamous cell carcinoma, adenoid cystic carcinoma, and sinonasal malignancies. • Benign Tumors: Including osteomas, ameloblastomas, and fibrous dysplasia. • Recurrent Infections or Osteomyelitis: In severe or refractory cases. • Trauma or Severe Infections: That involve extensive damage to the maxilla. II. Types of Maxillectomy: 1. Medial Maxillectomy: • Extent: Involves the removal of the medial wall of the maxilla, including the nasal cavity and ethmoid sinuses. • Indications: Used primarily for lesions involving the lateral nasal wall or ethmoid sinuses, such as inverted papilloma or localized squamous cell carcinoma. • Approach: Often performed endoscopically through a transnasal or transoral route. 2. Infrastructure Maxillectomy: • Extent: Involves the removal of the alveolar process, hard palate, and sometimes the lower portion of the maxilla below the orbital floor. • Indications: Appropriate for tumors confined to the lower half of the maxilla, sparing the orbital contents. • Approach: Transoral approach is typically used, sometimes combined with endoscopic techniques for better visualization. 3. Subtotal Maxillectomy: • Extent: Involves the removal of one or more walls of the maxilla while preserving key structures, such as the orbital floor and the medial wall. • Indications: Used for tumors involving multiple walls of the maxilla but not extending to the orbit. • Approach: Can be performed via lateral rhinotomy or midfacial degloving depending on tumor location and extent. 4. Total Maxillectomy: • Extent: Involves complete removal of the maxilla, including the hard palate, orbital floor, and sometimes the zygomatic arch. • Indications: Indicated for extensive malignant tumors that involve the entire maxilla and may extend to the orbit or adjacent structures. • Approach: Requires an external approach such as Weber-Ferguson incision, midfacial degloving, or combined craniofacial resection. 5. Extended Maxillectomy: • Extent: Goes beyond the total maxillectomy to include adjacent structures such as the pterygoid plates, orbital contents, or cranial base. • Indications: Reserved for very extensive tumors with involvement of the orbit, infratemporal fossa, or skull base. • Approach: May require craniofacial resection with combined neurosurgical and maxillofacial teams. 6. Orbital Exenteration: • Extent: Removal of the maxilla along with the contents of the orbit. • Indications: Required when the tumor invades the orbital tissues. • Approach: Requires a combination of maxillectomy and orbital surgery techniques. III. Surgical Approaches to Maxillectomy: 1. Transnasal Endoscopic Approach: • Uses: Primarily for medial maxillectomy or small tumors involving the lateral nasal wall and ethmoid sinuses. • Advantages: Minimally invasive, with reduced morbidity, faster recovery, and excellent visualization of the surgical field. • Limitations: Limited access for larger or more complex tumors, especially those extending into the orbit or cranial base. 2. Transoral Approach: • Uses: Suitable for infrastructure maxillectomy or lesions involving the lower maxilla and hard palate. • Advantages: Provides direct access to the palate and alveolar process with good cosmetic outcomes. • Limitations: Limited visualization for superior maxillary lesions or extensive lateral spread. 3. Lateral Rhinotomy: • Uses: Provides access for subtotal or total maxillectomy, especially for tumors involving multiple walls of the maxilla. • Advantages: Excellent exposure of the maxilla, nasal cavity, and paranasal sinuses. • Limitations: Involves a visible facial incision, with potential for noticeable scarring. 4. Weber-Ferguson Approach: • Uses: Provides wide access for total maxillectomy, especially when extensive resection of the maxilla and adjacent tissues is required. • Advantages: Allows excellent access to the maxilla, orbit, nasal cavity, and sometimes the anterior cranial base. 5. Midfacial Degloving: • Uses: Suitable for total or subtotal maxillectomy without external incisions, used for extensive maxillary tumors. • Advantages: Avoids external facial incisions, providing good cosmetic outcomes while maintaining excellent surgical exposure. 6. Craniofacial Resection: • Uses: Used for extended maxillectomies involving the cranial base, orbit, or infratemporal fossa. • Advantages: Provides the most extensive access to the maxilla, orbit, and skull base, allowing complete tumor resection.