OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. Th...OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. The tumors were classified according to the 2002 AJCC system. The TNM staging of the cases was as follows： 1 T4aN0M0, 2 T3N0M0 and 5 T2N0M0. Of the 8 cases, 1 patient underwent extended maxillectomy; exenteration of the orbit; tumorectomy of the sphenomaxillary and infratemporal fossae. Two patients received a total maxillectomy, and 5 a partial resection of the maxilla. Postoperative pathological report： 4 well-differentiated squamous carcinoma, 2 moderately-differentiated squamous carcinoma, 1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma.RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation, resect the tumor within a safe margin, and leave no facial cicatricles. One patient died of intracranial metastasis 8 months after operation. We observed no recurrences or metastasis in other patients during the period of follow-up.CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided. It has an advantage of minimal invasive surgery展开更多
Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects di...Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects disrupting two or more of the following facial axes:orbital,nasofacial,and palatal axes.Patients underwent primary reconstruction using an angular artery-based scapular tip-free flap with an osteotomy to fold the flap.Harvest techniques,including placement of osteotomies,folding and plating,surgical esthetic,and functional outcomes,are presented.Results:Osteotomies placed in the scapular tip-free flap allowed folding of the osseous flap and improved restoration of all three facial axes with a single flap.In one patient,the tip of the scapula was used to reconstruct the nasofacial axis,while the body and lateral border were used to reconstruct the palate.In four patients,the tip of the scapula was used to reconstruct the orbital axis,while the body and lateral border were used to reconstruct the nasofacial axis.Patients had successful oronasal separation,healed wounds withstanding adjuvant therapy,satisfactory orbital positioning and facial projection,preserved masticatory surfaces and opportunity for dental implants.Conclusion:The midface is geometrically complex and is one of the most challenging head and neck sites to reconstruct.Ablative defects in this area can disrupt facial axes resulting in poor esthetic and functional outcomes.This study demonstrates the reconstructive advantages of a novel osteotomized folded scapular tip-free flap.展开更多
文摘OBJECTIVE To investigate the feasibility of employing a modified midfacial degloving in maxillectomy. METHODS Eight patients with carcinoma of the maxillary sinus underwent a modified midfacial degloving operation. The tumors were classified according to the 2002 AJCC system. The TNM staging of the cases was as follows： 1 T4aN0M0, 2 T3N0M0 and 5 T2N0M0. Of the 8 cases, 1 patient underwent extended maxillectomy; exenteration of the orbit; tumorectomy of the sphenomaxillary and infratemporal fossae. Two patients received a total maxillectomy, and 5 a partial resection of the maxilla. Postoperative pathological report： 4 well-differentiated squamous carcinoma, 2 moderately-differentiated squamous carcinoma, 1 mucoepidermoid carcinoma and 1 adenoid cystic carcinoma.RESULTS A modified midfacial degloving operation can sufficiently expose a field of operation, resect the tumor within a safe margin, and leave no facial cicatricles. One patient died of intracranial metastasis 8 months after operation. We observed no recurrences or metastasis in other patients during the period of follow-up.CONCLUSION The major advantages of employing the modified midfacial degloving in maxillectomy is that a facial incision can be avoided. It has an advantage of minimal invasive surgery
文摘Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects disrupting two or more of the following facial axes:orbital,nasofacial,and palatal axes.Patients underwent primary reconstruction using an angular artery-based scapular tip-free flap with an osteotomy to fold the flap.Harvest techniques,including placement of osteotomies,folding and plating,surgical esthetic,and functional outcomes,are presented.Results:Osteotomies placed in the scapular tip-free flap allowed folding of the osseous flap and improved restoration of all three facial axes with a single flap.In one patient,the tip of the scapula was used to reconstruct the nasofacial axis,while the body and lateral border were used to reconstruct the palate.In four patients,the tip of the scapula was used to reconstruct the orbital axis,while the body and lateral border were used to reconstruct the nasofacial axis.Patients had successful oronasal separation,healed wounds withstanding adjuvant therapy,satisfactory orbital positioning and facial projection,preserved masticatory surfaces and opportunity for dental implants.Conclusion:The midface is geometrically complex and is one of the most challenging head and neck sites to reconstruct.Ablative defects in this area can disrupt facial axes resulting in poor esthetic and functional outcomes.This study demonstrates the reconstructive advantages of a novel osteotomized folded scapular tip-free flap.
