Maxillectomy Surgery in Delhi, India

Maxillectomy can be total or partial. Depending on which part of the maxilla is removed, there are different types of maxillectomy. The kinds of maxillectomy are:

1. Medial maxillectomy: In this maxillectomy, a part of the maxilla next to the nose is removed. This may be performed endoscopically or by making an incision on the face.
2. Infrastructure maxillectomy: In infrastructure maxillectomy, the hard palate (roof of the mouth), the lower part of the maxilla, and some teeth are removed. After this maxillectomy, reconstructive surgery or an obturator may be needed. 
3. Suprastructure maxillectomy: In this procedure, the upper part of the maxilla with the orbital floor (bone below the eye) is removed. In a few cases, the orbit may also be removed. Reconstructive surgery is essential if the eye is removed after the eye removal. 
4. Subtotal maxillectomy: Subtotal maxillectomy involves a variation in which a specific portion of the maxilla is removed. Reconstruction may be needed depending on the size and location of the tumour. 
5. Total maxillectomy: In total maxillectomy, the entire maxilla from one side along with the hard palate and orbital floor (bone below the eye) is removed. Reconstruction is needed in these cases.

The symptoms may include:

• Growth/ulcer over palate/ upper alveolus
• Nasal obstruction
• Nasal bleed
• Loss of smell
• Fullness over the cheek
• Loss of sensation over the cheek
• Bulging of the eyeball

The patient needs to be examined clinically, where the surgeon evaluates the extent of involvement of the disease. Imaging in the form of CT scan or MRI scan is essential to evaluate the deeper involvement in these cases.

If an obturator or dental plate is planned to cover the defect, then a dental impression is also taken before surgery.

• Do not eat or drink 8 hours before the surgery
• Notify the doctor about any medications all allergies the patient may have
• Do not take any blood-thinning medicines such as aspirin and Ibuprofen
• Depending on the type of maxillectomy, the doctor may suggest getting an impression to create a custom-made palate for creating a prosthesis. In such cases, the doctor may refer to a prosthodontist.
• Follow the advice given during pre-anaesthesia check-up.

The surgery for maxillectomy requires incisions over the face to access and remove the affected maxillary bones. Medial maxillectomy can be performed through the nostrils.

For any other type of maxillectomy, the procedure is as follows:

• The patient will receive general anaesthesia
• The surgeon will make an incision along the lip or nose or through the upper jaw, depending on the location of the tumour
• Once the maxilla is visible, the surgeon will insert tools and remove the tumour along with surrounding bones and soft tissue
• The surgeon may remove the hard palate, the lower part of the maxilla, the upper part of the maxilla, teeth, the orbital floor, or the bone near the nose.
• Depending on the type of maxillectomy, it may be followed by a reconstructive procedure.
• The incision will be closed with stitches.

A temporary feeding tube is placed to help the patient get proper nutrition till the wound heals. A breathing tube in the neck may be needed in select cases. Depending upon the type of reconstruction, the patient may be discharged in 3-7 days.

Reconstruction:

Reconstruction options include an obturator/dental plate or local flap, or free flaps (microvascular flaps).

The risks and complications include:

• Facial asymmetry
• Reaction to anaesthesia
• Infection
• Bleeding
• Numbness over the cheek
• Hematoma
• Enophthalmos
• Epiphora
• Vision problems or watery eyes 

Patients may need inputs from speech and swallowing therapists and dietitians to improve their swallowing and oral diet gradually.

Reviewed by Dr. Akshat Malik, Senior Consultant, Cancer Care / Oncology, Surgical Oncology, Head & Neck Oncology, Robotic Surgery on 15-Feb-2023.