Ocular Management and Aeromedical Certification of Maxillary Squamous Cell Carcinoma

This case report details the diagnostic, therapeutic, and aeromedical trajectory of a 58-yr-old pilot diagnosed with squamous cell carcinoma exhibiting perineural invasion and orbital floor involvement with treatment goal of return to flight. The malignancy presented with insidious symptoms of fascial swelling, numbness, and tingling, complicated by initial diagnostic anchoring bias. The patient had a relevant past medical history of squamous and basal cell carcinomas, including a Mohs micrographic surgery for a lesion on the left nares 10 yr prior.

Treatment necessitated a total maxillectomy with multiple skin flaps, and orbital floor reconstruction initially using a titanium implant and later an autologous scapular bone graft. Postoperative management addressed complex ocular manifestations, including mechanical diplopia and inferior rectus muscle dysfunction, alongside the challenges caused by multiple skin-flap failures.

From an aeromedical perspective, the case highlights the rigorous standards of the Federal Aviation Administration for First-Class medical certification, focusing on binocular fusion, visual acuity, and auditory thresholds. The report outlines the regulatory pathway for Special Issuance and the eventual return to flight duty, emphasizing the balance between aggressive oncological control and the preservation of critical sensory functions required for aviation safety. This case provides an example of a structured framework for managing high-stakes professional requirements in the context of advanced midfacial malignancy and complex reconstructive surgery. Krebsbach SK, Fredricks TR. Ocular management and aeromedical certification of maxillary squamous cell carcinoma. Aerosp Med Hum Perform. 2026; 97(8):644-647.