Lateral lip-splitting approach for total and subtotal maxillectomy.
OBJECTIVE
This study reviewed our patients who underwent maxillectomy by the lateral lip-splitting approach and evaluated postoperative outcomes.


METHODS
Thirty-six patients with diseases in the maxilla, maxillary gingiva, and hard palate who underwent total or subtotal maxillectomy by the lateral lip-splitting approach. The marginal mandibular branch of facial nerves were dissected and preserved before and after the procedure to split the lateral lower lip in all patients. Seventeen patients were reconstructed with free vascularized flaps. Postoperative radiotherapy was administered in 26 patients. The patient's self-assessment and examiner's evaluation were included in the postoperative assessment. The patient's self-assessment included answering a questionnaire, that included evaluation of buccal scar, symmetry of cheilion, lower lip movement, oral incontinence, and lower lip sensation. The examiner's evaluation included assessment of the functions of the facial nerve.


RESULTS
All tumors were removed en bloc with sufficient safety margins except 1 adenoid cystic carcinoma in maxilla. The average mouth opening was 3.81 cm. According to the results classified as good, fair, and poor by questionnaires, most of the 36 patients thought their results were good or fair. Most of the patients were high scores, according to the examiner's evaluation. The overall 5-year survival and local control rates for patients with malignant tumors were 76.7% and 85.8%, respectively. The local and regional recurrent and distant metastasis rate was 12.9%, 6.5%, and 19.4%, respectively.


CONCLUSIONS
The lateral lip-splitting approach is an acceptable and optional approach for maxillectomy because of wide exposure, satisfied function, inconspicuous scar, and preservation of facial nerve.
Sun
Jian
J
Department of Oral and Maxillofacial Surgery, the Ninth Affiliated Hospital, Shanghai Jiao Tong University, Shanghai, China. jianjian60@yahoo.com
Shen
Yi
Y
Weng
Yan-Qiu
YQ
Li
Jun
J
Zhang
Zhi-Yuan
ZY
D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D002921:Cicatrix / Q000473:pathology; D018572:Disease-Free Survival; D005154:Facial Nerve / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005887:Gingival Neoplasms / Q000601:surgery; D006801:Humans; D008046:Lip / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008340:Mandibular Nerve / Q000601:surgery; D008437:Maxilla / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009068:Movement; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010157:Palatal Neoplasms / Q000601:surgery; D017060:Patient Satisfaction; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods; D012677:Sensation / Q000502:physiology; D013524:Surgical Flaps; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult