Reconstruction of the maxilla and midface--surgical management, outcome, and prognostic factors.

Loss of the maxilla due to tumor ablation has both functional and aesthetic consequences. Even small defects become obvious because of missing bone and soft tissue. Reconstruction of the maxilla and midface in these patients presents a challenge to the surgeon although several possibilities are available for this purpose. The long term benefit to patients of the different modalities remains unclear due to wide individual variation. One hundred and twenty-one patients with maxillary oral squamous cell carcinoma were treated with curative intent. One hundred and five patients were surgically reconstructed using local or free microsurgical flaps. All parameters were collected from case records. Kaplan-Meier plots and univariate log-rank test and multivariate Cox proportional hazards regression models were used to determine the association between possible predictor variables and survival time of patients suffering from oral squamous cell carcinomas. After controlling for age, resection margins, nodal stage, and surgical management, which were independent and dependent predictors of survival, the type of reconstruction and involvement of surgical margins were associated with survival (HR=0.50, p=0.044, 95% CI, 0.25-0.98 and HR=3.16, p=0.007, 95% CI, 1.38-7.25). Various types of maxillary defects can be reconstructed successfully using different reconstructive techniques. The size and complexity of defects does not correlate with prognosis in oral squamous cell carcinoma patients. The criteria for reconstruction with a free flap were based on extensive defects in which local flaps were insufficient, on medical co-morbidities, and previous treatment.