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Long-term Results

Pramod K. Sharma, MD; David E. Schuller, MD; Joseph H. Goodman, MD; Stephen P. Smith; Fedrico P. Goldman, MS; Sonia Raj; Roy E. Nicholson, MB, ChB; Donn C. Young, PhD

Arch Otolaryngol Head Neck Surg. 1998;124:149-152.

Objective  To evaluate complications and sequelae of maxillary removal and reinsertion for anterior cranial base tumors.

Design  A retrospective review of patients who underwent maxillary removal and reinsertion from 1990 to 1996.

Setting  The Arthur G. James Cancer Hospital and Research Institute at The Ohio State University, Columbus.

Patients  A consecutive sample of 46 patients who underwent maxillary removal and reinsertion. The patients ranged in age from 11 to 77 years and were followed up for as long as 6 years after surgery. There were 16 benign and 30 malignant lesions.

Main Outcome Measures  Intraoperative, postoperative (1-10 days), short-term (11 days through 3 months), and long-term (>3 months) complications; survival status of patients; and adjuvant therapy.

Results  Four patients (9%) had undergone previous radiotherapy; 9 (20%) received intraoperative radiation therapy; and 23 (50%) received planned postoperative radiotherapy. No intraoperative complications were noted. The most common short-term complication found was transient diplopia, affecting 9 patients (20%). Diplopia resolved within 3 months in all but 2 patients, in whom the condition was permanent. There were 4 patients (9%) who required removal of the nasal dorsum plate, and 4 (9%) who required removal of maxillary plates that were exposed intranasally. Midface asymmetry as reported by the patient or noted on the physical examination was documented in only 2 patients. The most common long-term complication was nasal asymmetry, affecting 13 patients (28%).

Conclusions  Maxillary removal allows improved visualization and access to anterior skull base lesions, while reinsertion of the maxillary fragment provides functional preservation and excellent cosmesis with few short- or long-term complications, even when adjuvant radiotherapy is used.

From the Department of Otolaryngology, Comprehensive Cancer Center Head and Neck Oncology Program (Drs Sharma, Schuller, and Nicholson, Messrs Smith and Goldman, and Ms Raj), the Department of Surgery, Division of Neurosurgery (Dr Goodman), and the Comprehensive Cancer Center Biostatistics Unit (Dr Young), Arthur G. James Cancer Hospital and Research Institute, The Ohio State University, Columbus.

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