MAXILLARY REMOVAL AND REINSERTION FOR ANTERIOR CRANIAL BASE TUMORS - LONG-TERM RESULTS

Objective: To evaluate complications and sequelae of maxillary removal and reinsertion for anterior cranial base tumors. Design: A retrospec tive review of patients who underwent maxillary removal and reinsertio n 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, post operative (1-10 days), short-term (11 days through 3 months), and long -term (>3 months) complications; survival status of patients; and adju vant therapy. Results: Four patients (9%) had undergone previous radio therapy; 9 (20%) received intraoperative radiation therapy; and 23 (50 %) received planned postoperative radiotherapy. No intraoperative comp lications were noted. The most common short-term complication found wa s transient diplopia, affecting 9 patients (20%). Diplopia resolved wi thin 3 months in all but 2 patients, in whom the condition was permane nt. There were 4 patients (9%) who required removal of the nasal dorsu m 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 visu alization and access to anterior skull base lesions, while reinsertion of the maxillary fragment provides functional preservation and excell ent cosmesis with few short-or long-term complications, even when adju vant radiotherapy is used.