Prosthodontic guidelines for surgical reconstruction of the maxilla: A classification system of defects☆,☆☆,★,★★,♢
Section snippets
Functional anatomy for surgical reconstruction
The maxilla comprises the paired structures of the right and left maxillae.17 The body of each maxilla is hollow and shaped like a pyramid, with the base situated medially and adjacent to the nasal cavity. When the anatomy relevant to palatomaxillary reconstruction is considered, the maxilla can be conveniently divided into supportive buttresses and processes. The former constitute the foundation essential for resisting the forces of mastication, and the latter are responsible for the form of
Prosthetic prognosis and surgical reconstruction
Every effort should be made to re-establish a favorable distribution of force to achieve stabilization of an obturator prosthesis during mastication and function.18, 19, 20 The distribution of force derived from the metal framework and obturator bulb emulates the stable base that the native maxilla can provide for function. The engagement of structures within the defect diminishes the counterproductive lever forces placed on the obturator; contributes to the support, stability, and retention of
Proposed classification system
Defect classification systems enable surgeons and prosthodontists to use the characteristics of a particular defect to establish a functional prognosis. Since the publication of Ohngren's classification system for maxillectomy defects in 1933,33 a number of oncologically oriented classification schemes have served to describe the anatomic boundaries of the maxillectomy defect.34, 35, 36 Few classification systems, however, address the issues specifically related to reconstruction of the
Discussion
The palatomaxillary classification system presented here was based on clinical experience at Mount Sinai Medical Center, which was used to establish an algorithm for functional reconstruction, midface restoration, and orodental rehabilitation (Fig. 14).This system may provide a methodology to enroll larger patient numbers from multiple institutions to study various methods of rehabilitation.
The defect-oriented approach of the proposed system is
Summary
The classification system presented in this article may facilitate further study of the surgical reconstruction and prosthodontic rehabilitation of maxillectomy defects. Although the system does not address all factors related to the restorative decision-making process, it is intended as a guide and algorithm for reconstruction of the palatomaxillary defect.
Supplementary Files
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Clinical value of reconstruction with a soft tissue graft versus reconstruction with an obturator alone after partial maxillectomy: A systematic review
2024, Journal of Oral and Maxillofacial Surgery, Medicine, and PathologySoft Tissue Reconstruction of the Maxilla
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2024, Atlas of the Oral and Maxillofacial Surgery Clinics of North AmericaClassification of the Midface Defect: A Defect-Oriented Approach to Reconstruction
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2023, Journal of Oral and Maxillofacial Surgery
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aAssistant Professor, Departments of Dentistry and Otolaryngology-Head and Neck Surgery.
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bAssociate Professor, Department of Otolaryngology—Head and Neck Surgery.
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cProfessor and Chair, Department of Oral and Maxillofacial Surgery.
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dProfessor and Chair, Department of Otolaryngology—Head and Neck Surgery.
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Reprint requests to: Dr Devin Okay, Department of Otolaryngology—Head and Neck Surgery, The Mount Sinai Medical Center, Oral and Maxillofacial Associates, Box 1191, 5 East 98th St, 8th floor, New York, NY 10029, Fax: (212)427-4088, E-mail: [email protected]