The study purpose is to review the surgical approach and evaluate the results in managing patients with advanced midface and maxillary complex tumors. The most common anatomical site of the primary tumor was the maxilla, sometimes with extension to the orbit and anterior fossa, parotid and middle ear or even the lip. Surgical resection included maxillectomy in the majority of cases, combined with orbital exenteration or orbitectomy and anterior fossa resection. Parotidectomy and mastoidectomy/core petrosectomy were also performed. Reconstruction was performed with radial forearm osteocutaneous free flap, latissimus dorsi myocutaneous flap with scapular bone flap, lengthening temporalis myoplasty, rectus abdominis free flap, anterolateral thigh flap, in combination with temporalis and vastus lateralis, as well as pectoralis major myocutaneous flap. A total of 36 midface tumor excisions were performed, followed by the appropriate reconstruction. The average follow-up period was 15 years. To date, 23 patients are disease free, while 6 patients presented disease recurrence and 7 patients died during the 15-year follow-up period. Surgical resection remains the gold standard for midface tumors management. When safely performed, combined with microvascular and dynamic face reconstruction, surgery can offer improvement in quality of life and prolong the overall survival.

The aim of this retrospective cross-sectional study was to comprehensively assess masticatory function in maxillectomy patients with functioning removable prostheses. Their general and oral profiles, the measurement values of their oral functions, including masticatory function, and the history of tumor therapy were extracted from medical charts. The correlations of masticatory function with numerical data and the effects of tumor therapy-related factors on masticatory function were evaluated. In addition, a stepwise conditional logistic regression analysis was performed to identify the potential predictive factors comprehensively. The data from 55 maxillectomy patients revealed that the median value of masticatory function (138.0 mg/dL) was higher than the threshold (100.0 mg/dL) based on the concept of oral hypofunction. Moderate correlations of masticatory function with the number of remaining teeth, the number of functioning occlusal supports, and maximum occlusal force were found, as well as a weak correlation with maximum tongue pressure. These variables also showed statistically significant coefficients (p < 0.01). No significant effect of each tumor therapy-related factor on masticatory function was detected. A logistic regression analysis identified the number of functioning occlusal supports as a significant predictive factor. These results implied the crucial interactions of masticatory function with various factors and the specificities of maxillectomy patients.

UNASSIGNED: Caudal maxillectomies are challenging procedures for most veterinary surgeons. Custom guides may allow the procedure to become more accessible.
UNASSIGNED: A cadaveric study was performed to evaluate the accuracy and efficiency of stereolithography guided (3D-printed) caudal maxillectomy. Mean absolute linear deviation from planned to performed cuts and mean procedure duration were compared pairwise between three study groups, with 10 canine cadaver head sides per group: 3D-printed guided caudal maxillectomy performed by an experienced surgeon (ESG) and a novice surgery resident (NSG), and freehand procedure performed by an experienced surgeon (ESF).
UNASSIGNED: Accuracy was systematically higher for ESG versus ESF, and statistically significant for 4 of 5 osteotomies (p < 0.05). There was no statistical difference in accuracy between ESG and NSG. The highest absolute mean linear deviation for ESG was <2 mm and >5 mm for ESF. Procedure duration was statistically significantly longer for ESG than ESF (p < 0.001), and for NSG than ESG (p < 0.001).
UNASSIGNED: Surgical accuracy of canine caudal maxillectomy was improved with the use of our novel custom cutting guide, despite a longer duration procedure. Improved accuracy obtained with the use of the custom cutting guide could prove beneficial in achieving complete oncologic margins. The time increase might be acceptable if hemorrhage can be adequately controlled in vivo. Further development in custom guides may improve the overall efficacy of the procedure.

OBJECTIVE: Despite sharing the same staging system as oral cavity cancers, upper gingiva and hard palate (UGHP) squamous cell carcinoma (SCC) have several features that make them a different entity. We aimed to analyze oncological outcomes and adverse prognostic factors of UGHP SCC, and assess an alternate T classification specific to UGHP SCC.
METHODS: Retrospective bicentric study including all patients treated by surgery for a UGHP SCC between 2006 and 2021.
RESULTS: We included 123 patients with a median age of 75 years. After a median follow-up of 45 months, the 5-year overall survival (OS), disease-free survival (DFS) and local control (LC) were 57.3%, 52.7% and 74.7%, respectively. Perineural invasion, tumor size, bone invasion, pT classification and pN classification were statistically associated with poorer OS, DFS and LC on univariate analysis. On multivariable analysis, the following variable were statistically associated with a poorer OS: past history of HN radiotherapy (p = 0.018), age > 70 years (p = 0.005), perineural invasions (p = 0.019) and bone invasion (p = 0.030). Median survivals after isolated local recurrence were 17.7 and 3 months in case of surgical and non-surgical treatment, respectively (p = 0.066). The alternate classification allowed better patient distribution among T-categories, however without improving prognostication.
CONCLUSIONS: There is a broad variety of clinical and pathological factors influencing prognosis of SCC of the UGHP. A comprehensive knowledge of their prognostic factors may pave the way towards a specific and more appropriate classification for these tumors.

暂无摘要。

UNASSIGNED: The purpose of the study was to assess psychological status (PS) and quality of life (QOL) before surgical resection of maxilla (T0), 2 weeks after resection (T1), 2 weeks after use of intermediate obturator (T2), before (T3) and 12 weeks after use of definitive obturator (T4). 20 participants, planned for resection of maxilla and subsequent prosthodontic rehabilitation were enrolled. Assessment was done using Hospital Anxiety and Depression Scale (HADS) (HADS-A: anxiety and HADS-D: depression) for PS, World Health Organization Quality of Life BREF (WHOQOL-BREF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Head and Neck Module (EORTC QLQ- H&N35) for QOL, and obturator functioning scale (OFS) for obturator functioning. Six cases were dropped out. Highest HADS-A score was observed presurgically (18.7 ± 1.1) and highest HADS-D score at T1 (18.5 ± 1.8). After rehabilitation, HADS-A and HADS-D decreased significantly (P < 001). Least WHOQOL-BREF score was observed at T1, followed by a consistent, significant rise after rehabilitation at all time intervals (P < 001). Highest EORTC QLQ-H&N 35 score was observed at T1, with significant reduction (P < 0.001) after rehabilitation for all questions, except those related to sexual wellness (P = 1). Highest OFS were observed at T2 (3.1 ± 10.3) and least at T4 (1.9 ± 0.2). QOL and PS decline after maxillectomy. Patient education and rehabilitation with obturator leads to improvement in QOL and PS probably due to restored oral functions, and improved health of soft tissue. Both parameters improved with enhanced obturator quality and time.
UNASSIGNED: Reg. No. CTRI/2018/04/013164 http://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1&compid=19&EncHid=67729.89030.

UNASSIGNED: To evaluate the nutritional status (NS) of patients planned for maxillectomy and prosthodontic rehabilitation using three nutritional assessment methods.
UNASSIGNED: This longitudinal study enrolled 18 planned maxillectomy patients following the inclusion and exclusion criteria. NS was evaluated at five stages: before surgery (S0), 2 weeks after surgery (S1), 3 months after insertion of intermediate obturator (S2), just before fabrication of definitive obturator (S3), and 3 months after insertion of definitive obturator (S4) using two nutritional assessment tools i.e. Patient Generated -Subjective Global Assessment (PG-SGA) &Nutritional risk index (NRI); and body composition indicators i.e. body mass index (BMI), fat free mass (FFM), total body water (TBW), skeletal muscle mass (SMM) and skeletal muscle mass index (SMMI).To determine the changes in patient\'s nutritional status among different time points Repeated Measure ANOVA with Bonferroni post hoc adjustments was used.
UNASSIGNED: Out of 18 patients, 12 were completed the study. NS of maxillectomy patients deteriorates significantly (p < .05) till stage S2. At S3, significant improvement occurred as compared to stage S2, but it remained significantly less than pre-surgical level. However, at stage S4, all parameters were statistically comparable to S0 (p > .05) except for PG-SGA (p < .001) and SMM (p = .044).
UNASSIGNED: NS of maxillectomy patients worsen post surgically due to surgical morbidity and adverse effects of radiotherapy (RT) but improves with post-surgical healing, resolution of sequel of RT and improved oral function due to well-adapted obturator prosthesis.

UNASSIGNED: The aim of this study was conducted to evaluate the effect of socioeconomic status (SES) on psychological distress and treatment satisfaction levels of patients who underwent maxillectomy and rehabilitation with obturator prosthesis.
UNASSIGNED: Prospective, observational, analytic study.
UNASSIGNED: Forty-three patients undergoing maxillectomy were enrolled and divided into upper, middle, and lower SES groups, according to the updated Kuppuswamy SES scale. Psychological distress levels were assessed using Hospital Anxiety and Depression Scale (HADS) before maxillectomy (T0) and at 3 weeks after delivery of definitive obturator (T1). Treatment satisfaction levels with obturator prosthesis were assessed using Obturator Functioning Scale (OFS) at T1. HADS and OFS scores were then correlated with the SES of the participants.
UNASSIGNED: Out of 43 participants, 7 were lost to follow up. The total number of participants in upper, middle, and lower SES groups was 14, 11, and 11, respectively. Before surgery, there was no significant difference in anxiety levels (P > 0.05) among different SES groups. However, the depression levels were the highest in the lower SES and decreased significantly with increasing SES. Prosthetic rehabilitation led to statistically significant (P < 0.05) fall in the levels of both anxiety and depression assessed at 3 weeks after delivery of prosthesis. The upper SES group was found to be less anxious and depressed compared to middle and lower SES groups after prosthodontic rehabilitation. Treatment satisfaction level was found to be significantly low (P = 0.005) in lower SES group as compared to upper SES group while no difference was found in between the middle SES when compared to higher or lower SES groups.
UNASSIGNED: SES has a profound impact on the patient\'s psychosocial well-being and treatment satisfaction. Patients of lower SES reported with higher psychological distress and lesser treatment satisfaction compared to those belonging to upper SES.

To evaluate the effect of triangular mesh reduction on the trueness of digitized complete-arch dentate and edentulous maxillectomy defects models.
Twenty gypsum maxillectomy defect models (dentate and edentulous group: n = 10) were digitized using the Trios 3 intraoral scanner, scanning the teeth, mucosa and maxillectomy defect. These datasets (reference, R0) were saved as standard tessellation language (STL) files, and triangular mesh reduction was performed using the Meshmixer reduction tool. Digital test-datasets with file sizes reduced by 50%(R1), 75%(R2), and 90%(R3) were generated (each: n = 20). Each test-dataset was compared to the R0 file using a 3D evaluation software (GOM Inspect), applying automated pre-alignment followed by a best-fit alignment, and root mean square (RMS) 3-dimensional (3D) deviations were calculated. Statistical analyses were performed, at a level of significance of α=0.05.
The number of triangles, and STL file size were synchronized with each other and inversely proportional to the amount of mesh reduction. The resulting mean percentages of the STL file sizes were 50.00% for R1, 24.93% for R2, and 10.00% for R3. There were no 3D deviations at 50% triangular mesh reduction. The 3D deviations increased with the amount of mesh reduction: at 75% reduction the median deviations were lower (dentate:0.0016 mm, IQR:0.0015-0.0018; edentulous:0.0016 mm, IQR:0.0015-0.0016), than at 90% (dentate:0.004 mm, IQR:0.0038-0.0041; edentulous:0.003 mm, IQR:0.0036-0.0039). A statistically significant increase in 3D deviations was observed with higher degrees of mesh reduction (p<0.001).
Triangular mesh reduction results in a significant increase in 3D deviations if the reduction is more than 75%.
Digital models of patients with maxillectomy defects can be saved with a mesh reduction of 50% without affecting the trueness. The use of a 50% mesh reduction decreases the required storage capacity by 50%.

OBJECTIVE: To evaluate the effectiveness of prosthetic rehabilitation, as well as the quality of life (QOL) of older edentulous maxillectomy patients.
METHODS: Effectiveness of the complete denture obturator prosthesis and QOL of N = 44 older edentulous patients who had resection of the maxilla and were restored with a definitive prosthesis that was in use for a minimum of 1 year was assessed using three instruments: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), Head and Neck Cancer Module (QLQ-HN35), and Obturator Functioning Scale (OFS). Data analysis was performed by one-way analysis of variance (ANOVA) on ranks, Spearman rank-order correlation, and hierarchical multivariable rank regression at α = .05 level of significance.
RESULTS: Participants\' gender (P < .001), adjuvant treatment (P = .016), surgical approach (P = .017), size of the maxillary defect (P = .028), participants\' prosthetic history (P = .047), and dental status of the mandible (P = .038) were significantly related to the self-reported effectiveness of the complete denture obturator prosthesis. Perceived functioning of the prosthesis (P = .001), participants\' gender (P = .002), the American Society of Anesthesiologists (ASA) physical status (P = .027), and surgical approach (P = .039) were significant predictors of QOL.
CONCLUSIONS: Restoration of the edentulous maxillectomy defect is challenging. An effective definitive complete denture obturator appeared to be the strongest predictor for advanced quality of life in older maxillectomy patients. The physical status of the older participants significantly affected the overall QOL, but did not influence the self-reported functioning of the complete denture obturator prosthesis.