Abstract
The prognosis was evaluated in 41 patients who had undergone immediate reconstruction with a free flap for maxillary defects, at the National Cancer Center Hospital and the National Cancer Center Hospital East. Tumors were classified as T3 in 3 cases, and T4 in 13 cases, and 25 cases had recurred after initial treatment. The mean follow-up period was 26.8 months. Local recurrence was recognized in 30 patients, at from 1 to 36 months (mean, 5.2 months) after reconstruction. Twenty-five patients died due to recurrent tumor, 2 patients died due to other disease, five patients were surviving with recurrent tumor, and 9 patients were surviving disease-free. Our results indicate that the prognosis of patients with large maxillary defects, which require immediate reconstruction, is poor. Therefore, comparison with complicated reconstruction, which requires several flaps, prolonged operative time, and repositioning, simple reconstruction such as those that use the single flap and titanium mesh, is concerned and appropriate. For edentulous patients, it is very difficult to wear a denture if the palatal defect is completely closed. To resolve this problem, we developed a slit-type maxillary reconstruction to treat eight edentulous patients who underwent total or extended maxillectomy. Both the medial side of the nasal cavity and palatal defects were reconstructed by a single cutaneous portion of the free flap. In this procedure, a small nasal fistula (slit) was left at the medial site of the palate. Postoperatively, the maxillary prosthesis, with a process that was inserted into the reconstructed nasal fistula, was fabricated by the dental division. In seven of the eight patients, the postoperative speech, mastication, and deglutition ability was evaluated. Satisfactory functional results were obtained in all seven patients. Although long-term follow-up is necessary to confirm the stability of the maxillary prosthesis, this reconstructive method is simple and useful for edentulous patients after maxillectomy.
