Partial Maxillectomy Through an Upper

Cheek Flap Approach

• larger tumors of the upper gum and hard palate, or for those located
posteriorly, adequate exposure for resection is not feasible through a
peroral approach
• The design of the modified Weber-Ferguson incision is very important
for preservation of the aesthetics of the face

This approach requires a Depending on the location

modified Weber-Ferguson of the primary tumor and
incision with either a Lynch or the exposure necessary
a subciliary extension
Procedures
The Philtrum of the
upper lip is divided Exits the nasal vestibule
exactly in the midline and follows the ala of the
from the vermiliom nostril and the lateral
border up to thr aspect of the nose
columella

excision of a superficial
squamous cell carcinoma of
the mucosa of the right
cheek with skin graft
coverage several years ago
 The orbicularis oris and the musculature
A standard Weber-Ferguson around the ala of the right nostril are
incision is marked divided with the electrocautery up to the
anterior surface of the maxilla

A mucosal incision is now made in the upper gingivolabial and

gingivobuccal sulcus, leaving an appropriate cuff of mucosa and
soft tissues attached to the hard palate as a margin around the
periphery of the tumor
 A close-up view of the
exposure obtained thus far
shows the tumor freed up
anteriorly and laterally

The surgical specimen shows complete

removal of the primary tumor with a
generous cuff of normal mucosa on all
its margins and the alveolar process as
its medial margin

The surgical defect following removal of the

specimen shows absence of the lower half of
the maxilla and the posterior part of the
alveolar process, creating a direct
A previously fabricated
communication between the oral cavity and
surgical dental obturator is
the maxillary antrum (
now wired to the alveolar
process (
 The skin incision is A photograph of the oral
closed with 5-0 nylon cavity 3 months after surgery
interrupted sutures shows a well-healed skin
graft

This dental prosthesis

The prosthesis provides satisfactory restoration of speech and mastication. A effectively plugs the surgical
frontal view of the patient’s postoperative appearance with the dental defect and also incorporates
obturator in place shows a well-healed skin incision and an acceptable the remaining denture.
Immediate Reconstruction of the
Maxillectomy Defect
• Edentulous patients with an atrophic alveolar process and elderly
patients  unable to take care of the maxillectomy defect are best
reconstructed with a composite soft-tissue flap only, such as the
rectus abdominis free flap or anterolateral thigh flap
• Dental rehabilitation is completed with a removable denture, clasped
to the remaining teeth
POSTOPERATIVE CARE
• Oral Hygiene
• Oral Irrigations
• Humidified air
• Perioperative antibiotic is continued for 24 hours
• Tracheostomy care
• Oral alimentation
• Diet is progressively advanced to puréed, soft, and then regular food
during the next 10 days
• Nutrition via NGT
Outcomes
• Regional lymph node metastases become apparent, a significant drop in
overall and disease-specific survival rates is observed
• The 5-year disease-specific survival has ranged between 77% to 81%
• . The significant drop between disease-specific survival and overall
survival is attributed to comorbid conditions and other causes of death.
• adjuvant postoperative radiation therapy and chemoradiotherapy (in
patients with positive margins and extranodal spread), significant
improvement in locoregional control
• Long-term prognosis in these patients depends on the stage and extent
of multiple primary lesions.