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Locoregional recurrence following maxillectomy: implications for microvascular reconstruction
Ilya Likhterov1, Michael A Fritz2, Ivan H El-Sayed3
1Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York, U.S.A.
The Laryngoscope
|May 10, 2017
Summary
Maxillectomy reconstruction can improve quality of life, but monitoring for cancer recurrence is crucial. Early detection and intervention are key for successful salvage, especially for less severe defects.
Area of Science:
- Oncology
- Head and Neck Surgery
- Reconstructive Surgery
Background:
- Maxillectomy defect reconstruction aims to improve patient quality of life.
- Reconstruction may pose challenges for surveillance of recurrent malignancy.
- Understanding patterns of locoregional recurrence is vital for optimizing patient outcomes.
Purpose of the Study:
- To describe the pattern of locoregional recurrence after maxillectomy.
- To evaluate the impact of reconstruction on cancer surveillance.
- To assess the success of salvage surgery for recurrent disease.
Main Methods:
- Retrospective review of patients undergoing maxillectomy between 2001 and 2011.
- Analysis of recurrence patterns, timing, and associated factors.
- Evaluation of salvage surgery outcomes based on defect classification.
Main Results:
- Recurrence occurred locally in 25% of patients, primarily at 17 months postoperatively.
- Recurrence was associated with T4 disease, positive margins, and imaging surveillance.
- Salvage surgery was successful in 46% of cases, particularly for Brown class 1 or 2 defects.
Conclusions:
- Maxillectomy offers good locoregional oncologic control, dependent on initial disease stage and margins.
- Successful salvage for recurrent disease is limited in patients with Brown class 3 or greater defects.
- Physical exam and imaging are recommended for surveillance; reconstruction rarely impedes diagnosis.
