Patterns of Recurrence and Oncologic Outcomes After Maxillectomy: Does Reconstructive Modality Matter?

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.