Maxillectomy - Inferior

Considerations

- Indications
- tumors of the hard palate, and potentially alveolar ridge, that do not involve the floor of the maxillary sinus and nasal cavity
- Understand the tumor extenstion to plan your osteotomies
- Superficial and particularly benign lesions that do not invade the periosteum do not require through-and-through resection of the palate into the sinus and nasal fossa
- Tumors involving the alveolus may gain access to bone through invasion of the tooth sockets. In contrast, in well-localized tumors that are centrally located in the hard palate, preservation of the uninvolved alveolus is appropriate

This surgical approach is designed primarily for tumors of the hard palate that do not involve the floor of the maxillary sinus and nasal cavity. The extent of the tumor resection is drawn with a marking pen on the mucosa before beginning the actual osteotomies of the palate. The incisions are made in a manner similar to that described for tumors of the alveolar ridge ( Fig. 27-12 ). The maxillary sinus is entered and the inferior aspect of the maxillary sinus is evaluated ( Fig. 27-13 ). The sagittal saw is used for very precise osteotomies. The osteotomy is usually completed with the osteotome at the level of the pterygoid plates. The nasal cavity is entered and the septum is transected with heavy curved Mayo scissors. The soft palate is transected with electrocautery, and any residual soft tissue attachments are transected with scissors. After the mucosa of the maxillary antrum is removed as previously described, the inferior turbinate is also removed to prevent infection and edema, which interfere with the application of a palatal prosthesis. Once the specimen is removed, it is sent to the pathology laboratory for frozen section diagnosis. More extensive tumors limited to the hard palate and alveolar ridge can be removed by simply extending the osteotomies.

Sample operative report

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