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Partial maxillectomy for malignant neoplasms of para nasal sinuses and hard palate
Bubul C Roy1, Sudhir Bahadur, Alok Thakar
1Department of Otorhinolaryngology & Head and Neck Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 009, India.
Background:
The universal application of sectional imaging to the evaluation of para nasal sinus neoplasms has indicated that many of the regions encompassed in a total maxillectomy are often uninvolved and are perhaps unnecessarily resected.
Methods:
A set of guidelines was formulated regarding the indications and techniques of partial maxillectomies. These guidelines were then tested on a prospective cohort of 20 cases. The adequacy was judged by histological evaluation of all resection margins. Morbidity was assessed in terms of functional parameters (trismus, swallowing disturbances, speech disturbances) and cosmetic parameters (cheek retraction).
Results:
As per the pre-formulated guidelines a partial maxillectomy (PM) was suitable in ten and was undertaken. The same was unsuitable in the other ten and these therefore had a total maxillectomy (TM). Four of ten cases in each group had an involved resection margin. All such cases had additional treatment for the microscopic residual disease. In the four cases in the PM group with involved resection margins in none was this at the area with the limited resection. The status of the resection margins in these cases would not have been different even if they had had a total maxillectomy. Morbidity in the PM group was significantly less than in the TM group.
Conclusion:
By careful case- selection based on imaging, partial maxillectomy can provide for equivalent oncologic clearance as with a Total Maxillectomy, and significantly reduced morbidity.