Surgical Algorithm

Although management of each type of maxillectomy defect may vary somewhat -g according to the surgeon's preference, consideration of each individual defect | according to the aforementioned schema helps to narrow the reconstructive options significantly. Unless a free flap is definitely planned with complete obliteration of the c maxillary defect, the prosthodontist should be consulted preoperatively. ^

Type 1: Limited Maxillectomy o

Loss of only the anterior or medial walls of the maxillary sinus is inconsequential |

and requires no reconstructive or prosthetic management. Occasionally, the |

orbital rim must be sacrificed along with a variable quantity of cheek skin. These are small-volume but potentially large-surface-area defects that require bone for replacement of the orbital rim. Small cheek defects are best managed with cheek rotation or transposition. Larger defects not amenable to cheek rotation are managed with a radial forearm free flap. The underlying orbital rim defect is managed with a non-vascularized bone graft in any case. The osteocutaneous radial forearm flap should be avoided because of significant potential donor site morbidity.

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