Mid-facial reconstruction after maxillectomy

Reconstruction following extensive resection of the maxilla has been a challenging problem in the field of head and neck cancer surgery. At our institutes, maxillectomy defects have been restored based on the principles of repair involving the important concept of maxillary buttress reconstruction. Reconstruction of the zygomaticomaxillary buttress (ZMB), including the orbital floor, is essential for prevention of the malpositioning of the eyeglobe in preservation of the orbital contents. ZMB reconstruction is also important to provide a good contour of malar prominence. Pterygomaxillary buttress (PMB) reconstruction provides sufficient support for the fitting of a dental prosthesis. In patients with extensive resection of buccal soft tissue, a PMB and nasomaxillary buttress (NMB) should be reconstructed to prevent superior and posterior deviation of the alar base and oral commissure. We advocate that critical assessment of skeletal defects, as well as associated soft-tissue defects, following various types of maxillectomies is essential for a rational approach to achieve satisfactory clinical results.