Pictures of Total Maxillectomy and Obturator
This page was last updated: October 11, 2014

Total Maxillectomy for cancer of the maxillary sinus, resulting in a large defect in the roof of the mouth which communicates with the nose and nasopharynx. See enlarged picture below.

An Obturator is worn by the patient to seal the defect and allow the patient to eat and speak.

Magnified picture of total maxillectomy.  After removing the roof of the maxillary antrum, its floor (the hard palate) and its medial wall, one can look from the mouth and see the floor of the orbit, the ethmoid sinus and the nasopharynx.  Occasionally, the orbit is exenterated and its floor removed, thus resulting in one large cavity.

Maxillectomy and its classification.

Spiro RH, Strong EW, Shah JP.
Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA.
Head Neck. 1997 Jul;19(4):309-14.

BACKGROUND: Many adjectives are used to describe maxillectomy procedures, such as radical, total, extended, subtotal, medial, partial, and limited. The variety of nomenclature in our own Service database testifies that much confusion exists. METHODS: We have reviewed a 10-year experience with 403 maxillectomies performed between 1984 and 1993. Based on our retrospective reassessment, the operations were grouped into one of three categories. The term "limited" (LM) was applied to any maxillectomy which primarily removed one wall of the antrum. Designated "subtotal" (SM) was any procedure which removed at least two walls, including the palate. We listed as "total" (TM) only those who had a complete resection of the maxilla. Hospital charts were selectively reviewed, and each of the three types of maxillectomy was analyzed to determine the histology and site of the index cancers and the incidence of complex reconstruction. RESULTS: We determined that the maxillectomy performed in 230 patients (57%) was a LM. Tumor site and extent defined five different approaches in this cohort: peroral, 73; medial maxillectomy, 53; anterior craniofacial, 43; upper cheek flap, 42; and transfacial, 19. Subtotal maxillectomy or TM was performed in 135 and 38 (34% and 9%, respectively), almost 90% of whom had a cheek flap approach. Only 51 patients had an orbital exenteration, including 27 of the 38 (71%) of those who had a TM. Complex repair was employed in a total of 63 patients (16%), most often in those having TM (14 of 38, 37%). CONCLUSIONS: Classification of maxillectomy either as LM, SM, or TM is useful and feasible. To define a LM, the portion of the maxilla removed (ie, palate, anterior wall, medial wall) must be specified. For any maxillectomy, the access used should be listed, and the surgeon should indicate whether the maxillectomy has been extended to include adjacent structures.


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Bechara Y. Ghorayeb, MD
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