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Orbital preservation in maxillectomy

S J Stern1, H Goepfert, G Clayman

  • 1Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock 72205.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|July 1, 1993
PubMed
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For maxillary sinus cancer patients undergoing maxillectomy, preserving orbital contents often leads to poor eye function and high recurrence rates when the orbital floor is resected. Orbital exenteration may be considered in such cases.

Area of Science:

  • Oncology
  • Ophthalmology
  • Head and Neck Surgery

Background:

  • Squamous carcinoma of the maxillary sinus is a challenging diagnosis.
  • Maxillectomy is a common surgical approach for this condition.
  • Preservation of orbital contents during maxillectomy presents unique challenges.

Purpose of the Study:

  • To evaluate the outcomes of maxillectomy with orbital content preservation in maxillary sinus cancer.
  • To assess the impact of orbital floor resection and radiotherapy on ocular function and local recurrence.
  • To provide recommendations for surgical and adjuvant treatment strategies.

Main Methods:

  • Retrospective review of 28 untreated patients with maxillary sinus squamous carcinoma.
  • Patients underwent maxillectomy with orbital content preservation (1971-1986).

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  • Analysis of outcomes based on orbital floor resection, radiotherapy, and surgical approach.

    • Main Results:

    • 17% of patients with orbital floor resection retained significant ipsilateral eye function.
    • Local recurrence rates were high (44%) in patients with orbital floor resection, irrespective of radiotherapy.
    • Patients retaining the bony orbital floor experienced fewer complications if radiation fields excluded the eye.

    Conclusions:

    • Maxillectomy with orbital content preservation and orbital floor resection is associated with poor ocular function and high local recurrence.
    • Orbital exenteration should be strongly considered when the orbital floor is resected, particularly if adjuvant radiotherapy will involve the eye.
    • Careful consideration of surgical extent and adjuvant therapy is crucial for optimizing outcomes in maxillary sinus cancer.