Free flap reconstruction following endoscopic-assisted transoral partial maxillectomy

Maxillectomy was routinely performed via open rhinotomy to address locally advanced sinonasal malignancies, leading to anticipated cosmetic concerns due to the facial incision and oronasal deficit.

This study aimed to investigate the maxillectomy conducted via endoscopic-assisted transoral corridor without facial incision and reconstructed with free flap.

Cadaveric dissection was performed in 2 specimens to evaluate the feasibility of performing an endoscopic-assisted transoral maxillectomy without facial incision. Seven patients with locally advanced sinonasal lesions who underwent an endoscopic-assisted transoral maxillectomy and reconstructed with free flap were included. Peri-operative morbidities were assessed.

An endoscopic-assisted transoral maxillectomy was successfully performed on four cadaveric sides. For seven patients with locally advanced sinonasal lesions with inferior maxilla infiltration, endoscopic-assisted transoral maxillectomy was successfully completed and negative margins were achieved. Reconstruction with the anterolateral thigh flap and forearm flap were completed in four and three patients, respectively. Both the organ function and facial cosmetics were adequately maintained. No recurrence was detected with an average follow up of 26.86 months.

An endoscopic-assisted transoral maxillectomy reconstructed with the free flap serves as an alternative option for selected locally advanced sinonasal lesions infiltrating into the lower maxilla. With guarantee of the oncological outcomes, both the organ function and facial cosmetics are adequately maintained.