title: Quality of life factors and survival after total or extended maxillectomy for sinonasal malignancies.
abstract: OBJECTIVE
  Total and extended maxillectomy results in significant morbidity that can have an effect on quality of life factors. Modern reconstructive techniques have ameliorated this effect, but they have not been quantified. The purpose of the present study was to evaluate the quality of life factors and survival of patients undergoing total or extended maxillectomy for malignant disease.
  
  
  METHODS
  A retrospective study was performed of all patients who had undergone total or extended maxillectomy at a tertiary care cancer center from January 2008 to May 2013. The minimum follow-up period was 6 months. The quality of life factors analyzed included swallowing function and diet consistency, pain control, and postoperative complications.
  
  
  RESULTS
  A total of 25 patients (13 women and 12 men) met the inclusion criteria. Using the American Joint Committee on Cancer staging system, 76% of the patients had stage IV disease. Of the 25 patients, 13 received a free tissue transfer, 11 an obturator flap, and 1 a regional flap. None of the patients with a free tissue transfer experienced failure. The tumor size had no systemic influence on the reconstructive method chosen (P = .32 to P = .98). The median follow-up period was 41 weeks (range 24 to 252). One death was recorded, and 10 patients were lost to follow-up. Eleven patients progressed to a regular diet. Fifteen patients required a tracheostomy, and all were decannulated at a mean of 14 days postoperatively. One patient had dental implants placed. The type of reconstruction did not influence swallowing function (P = .49) or long-term pain (P = .38). The mean pain score was 4.9 ± 2.7. Pain management proved difficult in 7 patients. Also, 6 patients developed a surgical site infection, 3 of whom required a return to the operating room. Seven patients were readmitted to the hospital for complications; however, the reconstructive method did not influence the incidence of complications (P = .64).
  
  
  CONCLUSIONS
  The inevitable morbidity, with respect to quality of life factors, that result from the disfiguring effects of total or extended maxillectomy can be deemed acceptable by patients. We recommend discussing all reconstructive options regarding the management of late-stage maxillary malignancies and the potential effect they can have on patients' quality of life.
authors: Chief Resident, Department of Oral and Maxillofacial Surgery, University of Maryland Medical Center, Baltimore, MD.
authors: James
authors: J
authors: Murphy
authors: Chief Resident, Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland Medical Center, Baltimore, MD.
authors: Amal
authors: A
authors: Isaiah
authors: Associate Professor, Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD.
authors: Jeffrey S
authors: JS
authors: Wolf
authors: Assistant Professor and Fellowship Director, Department of Oral and Maxillofacial Surgery, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD. Electronic address: jlubek@umaryland.edu.
authors: Joshua E
authors: JE
authors: Lubek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003679:Deglutition / Q000502:physiology; D004032:Diet; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000523:psychology / Q000601:surgery*; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D010255:Paranasal Sinus Neoplasms / Q000523:psychology / Q000601:surgery*; D010359:Patient Readmission; D011183:Postoperative Complications; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000523:psychology*; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000637:transplantation; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D014139:Tracheostomy / Q000379:methods