What is a maxillectomy and how does it work?

The bone that makes up the top of your jaw is called the maxilla. The intermaxillary suture connects the right and left halves of the maxilla, which are irregularly shaped bones that fuse together in the middle of the skull, below the nose.

The maxilla is a major facial bone. It's also a part of the following skull structures:

the top jawbone, which contains the front of your mouth's hard palate

the lower sockets of your eyes

your sinuses and nasal canals on the sides and bottom

What is the function of the maxilla bone?

The maxilla is a portion of the viscerocranium, which is a part of your skull. Consider it to be the section of your skull that covers your face. The viscerocranium is made up of bones and muscles that help in a variety of basic processes like chewing, speaking, and breathing. During face injuries, this area protects the eyes, brain, and other organs by containing many essential nerves.

If your maxilla or surrounding bones are cracked, damaged, or wounded in any way, you may need surgery called maxillectomy.

What is a maxillectomy and how does it work?

The removal of all or part of the maxillary bone is known as a maxillectomy (the upper jaw). This procedure is used to treat both benign and malignant cancers of the hard palate, nose, and maxillary sinus, as well as any tumour that has spread to the maxilla.

There are several types of maxillectomy procedures:

Medial maxillectomy:-  The section of the maxilla closest to the nose is removed in a medial maxillectomy. This can be accomplished by making a facial incision (surgical cut) or employing tools through the nostrils (nose). Reconstructive surgery is rarely required.

Infrastructure maxillectomy:-  The hard palate (top of the mouth), the lower section of the maxilla, and the teeth are removed during an infrastructure maxillectomy. The orbital floor does not have to be removed (bone below the eye). Often, reconstructive surgery is required. 

Suprastructure maxillectomy:- The upper section of the maxilla and the orbital floor (bone beneath the eye) are removed in a suprastructure maxillectomy. The orbit (the bone that surrounds the eye) may be left in place in some cases. Reconstructive surgery is required due to the loss of the eye.

Subtotal maxillectomy:-  Using one of the foregoing methods, only a portion of the maxilla is removed.

Total maxillectomy:-  Removes the whole maxilla, as well as the hard palate and orbital floor, on one side (unilaterally) (bone below the eye). After this procedure, reconstructive surgery, potentially with prostheses, will be required.

Note: Depending on the procedure, chronic tearing of the eyes can be an issue for patients. This occurs because of a clog in the tubes that drain tears regularly. Small tubes may be inserted into the nose by your surgeon to allow the tears to drain. Other procedures, such as skin grafting, the implantation of a tracheostomy (tube/hole in the neck that allows you to breathe) and/or a feeding tube, may be required.

Some of these procedures need the use of prosthetic (artificial) devices to fill in the gaps left by the removal of bone from the roof of the mouth. This aids in eating, speaking, and swallowing as normally as possible. Skin grafts can also be held in place with the use of a prosthetic device.

What are the potential risks of a maxillectomy?

There are dangers and possible adverse effects with any procedure. These include:

  • Anaesthesia reaction (anaesthesia is the medication used to help you sleep through the surgery, forget about it, and control pain.) Wheezing, redness, oedema, and low blood pressure are all possible reactions.
  • Bleeding.
  • Hematoma is a type of haemorrhage (a collection of blood that will go away on its own or need to be treated with surgery).
  • Infection.
  • clots in the circulation, such as a pulmonary embolus (blood clot in the lung).
  • Enophthalmos is a condition that affects the eyes (a condition when the eye sinks into the cheek).
  • Numbness in the cheek due to nerve injury.
  • Numbness or a feeling of weakness.
  • Epiphora is a term that refers to (chronic eye tearing).

Your surgeon will discuss any additional risks with you prior to surgery, based on your health and the procedure you are undergoing.

Aftercare & Recovery

When a patient wakes up after surgery, they may have a tracheostomy tube or a feeding tube in place, as well as drains in their neck to help with fluid removal and infection prevention. To relieve any pain, the patient will be given pain medicines. After surgery, physical therapy or speech and swallowing therapy may be required as part of the rehabilitation process.

The length of recovery after a maxillectomy is determined by the degree of the operation and rebuilding. After a few hours of supervision in the recovery room, some procedures allow the patient to go home (endoscopic medial maxillectomy). Most maxillectomy procedures, on the other hand, may necessitate a longer stay in the hospital, likely for 1-2 days. Depending on the patient's past treatments and comorbidities, a significant reconstruction may need the patient to stay in the hospital for 5-7 days or longer.

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