Features of orbital floor reconstruction with free flap following maxillectomy for maxillary sinus cancer

Abstract

This study evaluates the outcomes of orbital floor reconstruction using free flaps after maxillary resection due to malignant neoplasms of the maxillary sinus.Materials and methods. A retrospective analysis was conducted on 30 patient medical histories who underwent maxillectomy with orbital floor removal due to malignant tumors and subsequent reconstruction using free flaps. Cross-sectional assessments to evaluate functional and aesthetic outcomes were performed in 25 alive and disease-free patients, with a follow-up of at least 180 days.Objective of the research. Bone reconstruction was performed in 25 patients, while five received reconstructions using soft tissue components. The most commonly used flap was a free flap from the fibula region. Normal visual acuity was observed in 82% of cases; physiological ocular movement was recorded in 89.3% of cases. Abnormal globe positioning occurred in nine patients. Aesthetic outcomes were satisfactory for 72.5% of the patients. Notably, orbital reconstructions without bone tissue components resulted in abnormal globe positioning in 67.7% of cases, although no statistically significant differences were found in visual acuity, ocular movement, and aesthetic satisfaction between patients who received bone versus soft tissue reconstruction (p ≤ 0.03). In 87% of cases at our clinic, we used bone reconstruction.The fibular region remains the optimal choice for the donor site. Soft tissue components were used in cases where the anteroposterior defect of the orbital floor averaged less than half of the total anteroposterior length, preserving the orbital rim. The absence of lower bony support and increased orbital cavity volume resulted in enophthalmos and hypophthalmos. Our findings confirm literature data indicating that bone reconstruction provides significantly better support for the eyeball than soft tissue reconstruction.Conclusions. It was established that free tissue transfer improves the outcomes of orbital floor reconstruction following total maxillectomy, preserving the eyeball and achieving optimal functional and aesthetic results. We believe that at the current stage of maxillofacial surgery development, preference should be given to bone reconstruction of the orbit. However, to obtain more precise and statistically reliable data, a larger multicenter study should be conducted with an adequate patient distribution across clinical groups for statistical analysis.