Definition & Overview
Maxillectomy is a surgical procedure used to partially or completely remove the maxilla bone, the central bone of the face that seals the roof of the mouth and forms part of the upper jaw. The procedure is performed in cases of facial tumour that affect the maxilla or any of its surrounding structures including the hard palate, maxillary sinus, and the nose.
Who Should Undergo and Expected Results
Maxillectomy is recommended for patients who have tumours on the maxilla bone (maxillofacial tumour) or nearby structures, including the maxillary sinuses, the nose, and the hard palate, among others. Examples of these tumours are:
- Maxillary carcinoma, or oral squamous cell carcinoma (SCC) affecting the floor of the mouth and its nearby bones
- Maxillary osteoblastoma, a rare tumour characterised by the presence of several osteoblasts that commonly occur in the long bones of the face such as the maxilla and the mandible
- Odontogenic tumours of the maxilla, such as radicular and dental cysts
- Sinonasal malignant tumours, or malignant tumours of the sinuses
- Osteoma, or tumours that affect the maxillofacial region
- Chondroma, or tumours of the nasal cavity
- Intraosseous hemangioma, which commonly affects the maxilla and the nasal bone
- Osteosarcoma, or malignant tumours that develop in the maxilla or mandible
Maxillofacial bone tumours may arise from the bone’s osteogenic, chondrogenic, vascular, hematopoietic, or fibrogenic elements and may cause a wide range of symptoms, such as:
- Localised facial pain
- Nasal obstruction resulting in congestion
- Cheek paresthesia
- Reduced sense of smell
- Mucus discharge from the nose
- Post-nasal drip
There are many different kinds of maxillectomy performed depending on the location and extent of the tumour. For severe tumours that have spread across the maxilla, a total maxillectomy is usually necessary. This removes the entire maxilla bone, including the hard palate and the orbital floor, as opposed to just a part of it or a partial maxillectomy.
Partial maxillectomies, on the other hand, come in different types depending on which part of the maxilla is removed. These include:
- Medial maxillectomy – This is usually indicated in the case of nasal tumours and only the part of the maxilla on the side of the nose is removed.
- Infrastructure maxillectomy – This involves the surgical removal of the hard palate and the lower maxilla. The area is then reconstructed using an obturator or free flap.
- Suprastructure maxillectomy – This refers to the removal of the upper part of the maxilla and the orbital floor. It is followed by the reconstruction of a new orbital floor to keep the eye in place.
- Subtotal maxillectomy – Other forms of partial maxillectomy that remove at least two walls of the maxilla bone including the palate are classified as subtotal maxillectomy.
A maxillectomy is usually followed by a reconstructive procedure or, in some cases, a skin graft, to seal the opening that the procedure left behind.
Studies show that subtotal and total maxillectomies are less common with more than half of all the cases being partial and limited (medial, infrastructure, and suprastructure) in nature.
How is the Procedure Performed?
A maxillectomy is typically an invasive procedure that requires an open incision to access the maxilla bone. Only a medial maxillectomy can be performed using advanced minimally invasive techniques and through the nostrils. All other types are performed in the traditional manner.
On the day of the surgery, the patient is placed under general anaesthesia, and the surgeon begins the procedure by making an incision through the upper jaw, along the lip, or along the nose, depending on the exact location of the tumour. This will give him access to the surgical area and be able to remove the tumour and the bones that surround it.
This is followed by a reconstructive procedure to maintain the integrity of the facial structure despite the absence of some or all of the maxilla bones. This is achieved by taking healthy tissue from another part of the patient’s body to cover the gap in the maxilla area.
Possible Risks and Complications
Risks associated with maxillectomy include:
- Temporary tear duct damage, which can cause chronic tearing
- Epiphora, or watery eyes due to surgical swelling
- Vision changes
- Glue ear, or congestion in the ear canal
- Flap failure
- Thrombosis, or blood clot
- Persistent tumour, or recurrence of the tumour
- Haematoma, or blockage of the drainage tubes placed after surgery resulting in a clot
Due to the role of the maxilla in speech and language as well as in eating and drinking, a maxillectomy can affect these functions and the patient may require speech and language therapy and well as some dietary adjustments and support after the procedure.
Spiro RH., Strong EW., Shah JP. “Maxillectomy and its classification.” Head Neck. 1997 Jul;19(4):309-14. http://www.ncbi.nlm.nih.gov/pubmed/9213109
Bokhari K., Hameed MS., Ajmal M. Togoo RA. “Benign osteoblastoma involving maxilla: A case report and review of the literature.” Case Reports in Dentistry. http://www.hindawi.com/journals/crid/2012/351241/