Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2025
Patterns of Recurrence and Oncologic Outcomes After Maxillectomy: Does Reconstructive Modality Matter?
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Lee Cameron, Wasay Salim Abdul, Jenkins Glyndwr, Moyer Kelly, Hatten Kyle, Wolf Jeffrey S, Taylor Rodney, Lubek Joshua, Dyalram Donita
Аннотация
BACKGROUND: Reconstruction following maxillectomy for oral cavity malignancies is essential for restoring form and function. Obturator reconstruction facilitates direct visualization of the surgical bed, whereas flap-based reconstructions may obscure sites of potential recurrence. This has raised concern that reconstructive modality could influence the timeliness of recurrence detection, and subsequently, oncologic outcomes.
PURPOSE: The purpose of this study was to measure the association between reconstructive modality and time to detection of local recurrence and survival outcomes.
STUDY DESIGN, SETTING SAMPLE: This was a retrospective cohort study of all patients undergoing maxillectomy for an oral cavity malignancy at the University of Maryland between 2016 and 2024. Patients previously undergoing maxillectomy were excluded.
PREDICTOR VARIABLE: The predictor was reconstructive modality: obturator versus native tissue reconstruction (local, regional, or free flap).
MAIN OUTCOME VARIABLE: The primary outcome was local disease-free survival. Secondary outcomes included overall survival, method of recurrence detection (clinical vs radiographic), and resectability of recurrence.
COVARIATES: Covariates were categorized into demographic (age, sex), perioperative (Brown classification), and pathologic (margin status, tumor stage).
ANALYSES: Descriptive statistics were computed for study variables. Associations between study covariates and time to local recurrence were evaluated using bivariate Cox proportional hazards models.
RESULTS: The cohort was composed of 154 subjects with a mean age of 66.5 ± 14.9 years and 90 were male (58.4%). Fifty subjects (32.5%) underwent obturator reconstruction and 104 (67.5%) underwent reconstruction with native tissue (75% free flap). Reconstructive modality was not associated with local disease-free survival (P = .9), method of detection (P = .4), or overall survival (P = .3). Local recurrence occurred in 41 subjects (26.6%), with 14 (34.1%) in the obturator group compared to 27 (65.9%) in native tissue (P = .7). The median time to local recurrence was 7.7 months (interquartile range 26.2 months). Most recurrences (75.6%) were detected clinically. Subgroup analysis of Brown 2 defects confirmed the similar findings.
CONCLUSIONS AND RELEVANCE: Reconstructive modality was not associated with delayed detection of local recurrence or worse survival outcomes following maxillectomy for oral cavity malignancies.
PURPOSE: The purpose of this study was to measure the association between reconstructive modality and time to detection of local recurrence and survival outcomes.
STUDY DESIGN, SETTING SAMPLE: This was a retrospective cohort study of all patients undergoing maxillectomy for an oral cavity malignancy at the University of Maryland between 2016 and 2024. Patients previously undergoing maxillectomy were excluded.
PREDICTOR VARIABLE: The predictor was reconstructive modality: obturator versus native tissue reconstruction (local, regional, or free flap).
MAIN OUTCOME VARIABLE: The primary outcome was local disease-free survival. Secondary outcomes included overall survival, method of recurrence detection (clinical vs radiographic), and resectability of recurrence.
COVARIATES: Covariates were categorized into demographic (age, sex), perioperative (Brown classification), and pathologic (margin status, tumor stage).
ANALYSES: Descriptive statistics were computed for study variables. Associations between study covariates and time to local recurrence were evaluated using bivariate Cox proportional hazards models.
RESULTS: The cohort was composed of 154 subjects with a mean age of 66.5 ± 14.9 years and 90 were male (58.4%). Fifty subjects (32.5%) underwent obturator reconstruction and 104 (67.5%) underwent reconstruction with native tissue (75% free flap). Reconstructive modality was not associated with local disease-free survival (P = .9), method of detection (P = .4), or overall survival (P = .3). Local recurrence occurred in 41 subjects (26.6%), with 14 (34.1%) in the obturator group compared to 27 (65.9%) in native tissue (P = .7). The median time to local recurrence was 7.7 months (interquartile range 26.2 months). Most recurrences (75.6%) were detected clinically. Subgroup analysis of Brown 2 defects confirmed the similar findings.
CONCLUSIONS AND RELEVANCE: Reconstructive modality was not associated with delayed detection of local recurrence or worse survival outcomes following maxillectomy for oral cavity malignancies.