Management of acquired maxillary and hard palate defects
- Daniel Buchbinder, DMD, MD
Daniel Buchbinder, DMD, MD
- Professor and Chief Maxillofacial Surgery, Dept. of Otolaryngology Head and Neck Surgery
- Icahn School of Medicine at Mount Sinai, New York, NY
- Devin J Okay, DDS
Devin J Okay, DDS
- Division of Prosthodontics
- Mount Sinai Beth Israel
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Head and neck cancer and its treatment can cause significant difficulties in orofacial function and thus impair quality of life. When surgery results in a maxillary defect, morbidity can be due to nasal regurgitation (food, liquid, and sound) through the defect, loss of teeth and the inability to chew properly, malnutrition, impaired speech, and distortion of the facial appearance. Severe psychological issues can be a secondary consequence of these complications.
The approach to managing maxillary defects, including both the use of a prosthesis (obturator) and surgical reconstructive techniques, will be reviewed here. The management of soft palate and mandibular defects is discussed separately. (See "Mandibular and palatal reconstruction in patients with head and neck cancer".)
GOALS OF TREATMENT
The goal of treatment is to restore function (mastication, swallowing, speech) and a normal appearance to the face. This may be accomplished either through artificial closure of the defect using an obturator prosthesis or through surgical reconstruction of the defect.
To do this requires:
●Closure of the defect between the oral and nasal/sinus cavities
- Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: a classification system of defects. J Prosthet Dent 2001; 86:352.
- Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM. Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck 2010; 32:860.
- Genden EM, Okay D, Stepp MT, et al. Comparison of functional and quality-of-life outcomes in patients with and without palatomaxillary reconstruction: a preliminary report. Arch Otolaryngol Head Neck Surg 2003; 129:775.
- Minsley GE, Warren DW, Hinton V. Physiologic responses to maxillary resection and subsequent obturation. J Prosthet Dent 1987; 57:338.
- Watson RM, Gray BJ. Assessing effective obturation. J Prosthet Dent 1985; 54:88.
- Shipman B. Evaluation of occlusal force in patients with obturator defects. J Prosthet Dent 1987; 57:81.
- Funk GF, Laurenzo JF, Valentino J, et al. Free-tissue transfer reconstruction of midfacial and cranio-orbito-facial defects. Arch Otolaryngol Head Neck Surg 1995; 121:293.
- Muzaffar AR, Adams WP Jr, Hartog JM, et al. Maxillary reconstruction: functional and aesthetic considerations. Plast Reconstr Surg 1999; 104:2172.
- Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck 1996; 18:412.
- Funk GF. Scapular and parascapular free flaps. Facial Plast Surg 1996; 12:57.
- Futran ND, Haller JR. Considerations for free-flap reconstruction of the hard palate. Arch Otolaryngol Head Neck Surg 1999; 125:665.
- Chen HC, Ganos DL, Coessens BC, et al. Free forearm flap for closure of difficult oronasal fistulas in cleft palate patients. Plast Reconstr Surg 1992; 90:757.