Current Concepts in Maxillary Reconstruction

Management of a Partially Treated Case of Chronic Osteomyelitis of the Hard Palate and Maxillary Sinus

Osteomyelitis affects bones, including both cortex and medulla. It influences the mandible more frequently than the maxilla. Probable etiologic factors include foci of infection or trauma; however, the hematogenous spread of infection from a distant site is also a causative factor. Staphylococcus is the common organism involved in the causation. Clinical symptoms include signs of inflammation, pus drainage, fistulous or sinus tracts, wound disintegration, erythema, and raised local temperatures. Laboratory diagnosis with the evaluation of white blood cell count, rate of erythrocyte sedimentation, and C-reactive protein proves vitally significant. Radiographic evaluation reveals sequestra and bone destruction in the affected region. Histopathology of the lesion is confirmatory for the final diagnosis, which helps in the formulation of an appropriate management strategy. The treatment regimen usually focuses on thorough debridement of the necrotic material and an antibiotic regimen. This case report describes a male patient aged 45 years presenting with a palatal ulcer, severe halitosis, and speech difficulty. He has suffered from type II diabetes mellitus for four years. A radiological examination was carried out. Treatment was performed with surgical debridement of necrotic maxillary bone and curettage of bilateral maxillary and ethmoid sinuses under general anesthesia. Results of histopathological evaluation of the curetted material from the maxillary and ethmoid sinuses revealed osteomyelitis of the maxilla.

Reconstruction of Total Maxillectomy Defects Using Coronoid-Temporalis Pedicled Flap, Titanium Mesh, and Free Flap

The maxilla plays a crucial role in maintaining midfacial contour, supporting the globe and dentition and separating the oral and nasal cavity. Reconstruction of total maxillectomy defects has always been a challenge in head and neck surgery. In recent years, on the basis of existing methods, we have used the coronoid-temporalis pedicled flap combined with personalized titanium mesh and free flap to reconstruct total maxillectomy defects. This combination of multiple methods can restore the functional subunits of the maxilla. In this report, we introduce our surgical procedures in detail and assess the postoperative effects. Postoperative facial aesthetic outcomes were satisfactory in all 8 patients. None of the patients showed diplopia, oral-nasal reflux, hypernasality, titanium mesh exposure, or trismus. This new surgical procedure may be a simple and feasible option for the reconstruction of total maxillectomy defects.

Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy

Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy.