Total maxillectomy with free scapula tip flap reconstruction: Airway management, aesthetic and functional results

Airway management and evaluation of functional and aesthetic results after total maxillectomy and chimeric osteo-musculo-cutaneous scapula tip flap reconstruction without tracheotomy.

A single-center retrospective study of patients with malignant or benign maxillary bone or sinus tumors managed by total maxillectomy and free scapula tip flap reconstruction between January 2015 and July 2023 was performed. Data collected allowed postoperative airway management analysis. The EORTC QLQ-C30 and H&N43 questionnaires, DASH, UW-QOL-V4 and the FOIS scale were used for functional and aesthetic assessments.

Analyze the perioperative data of patients operated on. Secondary objective was to evaluate functional and aesthetic results.

Sixteen patients underwent total maxillectomy with scapula tip free flap reconstruction during the study period. Twelve (75%) patients spent an average of one day in the intensive care unit (ICU), 12 patients (75%) were extubated immediately at the end of surgery, the remaining 4 patients were extubated on day 1. No patient required re-intubation or tracheotomy. The pulmonary complication rate was low (6.2%). The mean time to resumption of feeding was 7.3 (±1.8) days, and the mean hospital stay was 14 (±3.8) days. Functional analysis was performed on 11 patients. More than half the patients had a normal diet. No patients limited their activities because of their appearance.

This series shows that it is possible to perform this surgery without systematic tracheotomy. A good aesthetic result and satisfactory recovery of functional and swallowing abilities is possible.