Combined Endoscopic and Transoral Approach for Total Maxillectomy

Abstract

The technique of maxillectomy has been revised since it was first described in the 1820s. During the past decade, the endoscopic approach has been widely practiced for resecting maxilla. Compared with the traditional approaches, the combined endoscopic and transoral approach has many advantages such as avoiding facial incisions and postoperative scars and better visualization of the surgical margin. However, this technique is complicated to master and possess several challenges. Here, we demonstrate this approach step-by-step to show how to perform a total maxillectomy. We also reported nine cases with malignant tumors originating from the maxilla, and for all of them total maxillectomy was performed with combined endoscopic and transoral approach. Our data showed that the combination of the endoscopic and transoral approach could be used to resect the total maxilla successfully, though the tumor extended to the infratemporal and pterygopalatine fossa should be treated very carefully to avoid its spread in the local area. Furthermore, besides denture, other reconstruction methods should be attempted to improve the postoperative quality of life after the total maxillectomy.

Introduction

The squamous cell carcinoma from the maxillary sinus reports the highest incidence among the tumor developments within the sinonasal compartment¹. Besides squamous cell carcinoma, the pathological patterns of maxillary tumors also include various histological types, such as adenocarcinomas, melanoma, and esthesioneuroblastoma, etc.². Since the symptoms in the early phases are dormant and nonspecific, most of the patients diagnosed with malignant tumor originating from the maxilla are in an advanced stage during the time of diagnosis. This makes the maxillary malignant tumors one of the worst in comparison with other head....

Protocol

This procedure was approved by the Institutional Review Board of the Eye and ENT Hospital, Fudan University, China. A written informed consent was obtained from all the enrolled patients.

1. Preparation for the surgery

1. Before the surgery, examine the patients with anterior rhinoscopy, 4 mm endoscopy, computed tomography (CT), and Magnetic Resonance Imaging (MRI) scans to confirm the maxillary bone was invaded by the tumor and that a total maxillectomy is required. Make the surgical plan based on the location of the tumor.
2. On the day of the operation, place the patient on the operating table and then give general anesth....

Results

In this study, we presented the details of the surgical protocol to resect the total maxillectomy with a combined endoscopic and transoral approach. We also included nine cases who were diagnosed with malignant tumors that originated from maxillary sinus and were treated in the Eye and ENT hospital of Fudan University. The combined endoscopic and transoral approach on all the patients was performed and clear surgical margins were achieved in all the patients. The patients' mean age was 47.9 years (with a range of 18-69 y.......

Discussion

In this work, we demonstrated an endoscopic approach to resect the total maxilla. Our results showed that this approach was effective and safe to achieve its goal, which is consistent with previous cadaveric⁸ and clinical studies⁹. Nine patients with malignant tumor originated from maxillary sinus were treated with this endoscopic approach. All of their information was recorded, and the length of their follow-up ranged from 2 months to 32 months. During the follow-up period.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Carborundum drill	Medtronic, Inc.	REF15BA60D
Curved sinus blade	Medtronic, Inc.	REF1884006	11 cm x 4 mm
Dynamic planing system	Medtronic, Inc.	REF1898001
Electrocoagulation	Shanghai Hutong Electronics. Co.,Ltd	GD350-B5
Epinephrine	Shanghai Harvest Pharmaceutical Co., Ltd	10170405
Fret Saw Wire Instruments	Shanghai Medical Instruments (Group) Ltd., Corp. Surgical Instruments Factory	N30030
Gauze	Ningbo Shenyuan Medical Material Co., Ltd		6 cm x 60 cm
Mastoid Retractor	Shanghai Medical Instruments (Group) Ltd., Corp. Surgical Instruments Factory	NH6F090	Lengh: 16 cm
Mayo scissors	Shanghai Medical Instruments (Group) Ltd., Corp. Surgical Instruments Factory	J22040	Lengh: 16 cm
Metzenbaum scissors	Shanghai Medical Instruments (Group) Ltd., Corp. Surgical Instruments Factory	JC2514	Lengh: 25 cm
Nasal Endoscopy	Karl Storz-Endoskope	7230 AA
Plasma (EVAC 70 Xtra HP With integrated Cable)	Smith & Nephew	EIC5874-01
Quadcut blade	Medtronic, Inc.	REF1884380HR	4.3 mm
Suction Elevator	Zhejiang Tian Song Medical Products Co., Ltd	B2117.1	Width: 4 mm
Tetracaine	Eye & ENT Hospital of Fudan University	180130
Trans-Nasal Skull Base Bur	Medtronic, Inc.	REFTN45RCD	13 cm x 4.5 mm