Surgical techniques improve outcomes for midface oncologic defects reconstruction
MedWire News: Functional and aesthetic outcomes of midface reconstruction of oncologic defects have significantly improved over the past 15 years, show findings from a report discussing advances in surgical techniques.
In the second part of a 15-year (1992-2006) review of midface reconstruction after total and subtotal maxillectomy, Peter Cordeiro (Memorial Sloan-Kettering Cancer Center, New York, USA) and team performed a chart review of 100 flaps for midface oncologic reconstruction.
Over time, technical improvements were made in the following areas: palate, dental implants and prosthesis, orbital floor, eyelid, nasal sidewall, lips, cranial base and dura, and pedicle anastomosis. All outcomes were subjectively evaluated and graded by two separate surgeons.
When the team compared functional and aesthetic outcomes of the first 50 flaps performed during 1992-2000 with the second set of 50 flaps performed during 2001-2006, they found that improvements in palatal reconstruction increased the proportion of patients who were able to achieve normal speech from 38.9% to 50.0%. Furthermore, the percentage of patients who were able to tolerate an unrestricted diet increased significantly from 44.4% to 52.0%.
Both improvements were made possible by minimizing the size of the skin island and increasing the use of dental implants.
For the orbital floor and eyelid, use of the tongue-in-groove technique and a modification of the Weber-Fergusson incision lowered the ectropion rate by almost 25.0%, from 71.4% to 47.6%.
Cordeiro and team also report surgical advances for the nasal sidewall, lips, cranial base and dura. When approaching surgery of the nasal sidewall, inserting a separate skin island and using packing was found to help keep the airway open. Oral competence was maintained by employing a lip-switch procedure, while careful separation of the brain from the nasopharynx minimized cerebrospinal fluid leaks.
Management of pedicle anastomosis was achieved by using branches of the external carotid artery and internal jugular vein to minimize microvascular complications.
Finally, the percentage of patients whose aesthetic results were judged as "excellent" increased significantly from 12.0% to 58.6%.
Despite these advances, the researchers say "there are still many unsolved problems that still remain which leave the path open for future advances."
The full report of surgical techniques is published in the journal Plastic Reconstructive Surgery.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Ingrid Grasmo