MAXILLECTOMY AND ITS CLASSIFICATION

Background. Many adjectives are used to describe maxillectomy procedur es, such as radical, total, extended, subtotal, medial, partial, and l imited. The variety of nomenclature in our own Service database testif ies that much confusion exists. Methods. We have reviewed a 10-year ex perience with 403 maxillectomies performed between 1984 and 1993. Base d on our retrospective reassessment, the operations were grouped into one of three categories. The term ''limited'' (LM) was applied to any maxillectomy which primarily removed one wall of the antrum. Designate d ''subtotal'' (SM) was any procedure which removed at least two walls , including the palate. We listed as ''total'' (TM) only those who had a complete resection of the maxilla. Hospital charts were selectively reviewed, and each of the three types of maxillectomy was analyzed to determine the histology and site of the index cancers and the inciden ce of complex reconstruction. Results. We determined that the maxillec tomy performed in 230 patients (57%) was a LM. Tumor site and extent d efined five different approaches in this cohort: peroral, 73; medial m axiliectomy, 53; anterior craniofacial, 43; upper cheek flap, 42; and transfacial, 19. Subtotal maxillectomy or TM was performed in 135 and 38 (34% and 9%, respectively), almost 90% of whom had a cheek flap app roach. Only 51 patients had an orbital exenteration, including 27 of t he 38 (71%) of those who had a TM. Complex repair was employed in a to tal of 63 patients (16%), most often in those having TM (14 of 38, 37% ). Conclusions. Classification of maxillectomy either as LM, SM, or TM is useful and feasible, To define a LM, the portion of the maxilla re moved (ie, palate, anterior wall, medial wall) must be specified. For any maxillectomy, the access used should be listed, and the surgeon sh ould indicate whether the maxillectomy has been extended to include ad jacent structures. (C) 1997 John Wiley & Sons, Inc.