Audit of maxillectomy at Wits maxillofacial and oral surgery unit

Abstract

Aim: The aim of this study was to retrospectively audit maxillectomy performed at Wits Oral Health Centre (WOHC) over a ten (10) year period from January 2008 to December 2018. Objectives: To describe the profile of the patients who underwent maxillectomy in the Maxillofacial and Oral Surgery (MFOS) department; to evaluate the patterns of maxillectomies in the MFOS department and to determine the indications for maxillectomy in the MFOS department. Materials and Methods: This is a cross-sectional retrospective study of the patients who underwent maxillectomy at WOHC, University of Witwatersrand, Johannesburg. The study included patients from both Maxillofacial and Oral surgery units in Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Chris Hani Baragwanath Academic Hospital (CHBAH). Records of patients from 2008 to 2018 were obtained from outpatient departments and theatres of both hospitals. Data collected for evaluation included the age of patients; gender; aetiology of maxillectomy; classification of maxillectomy according to Brown's classification (2010); rehabilitation modality and complications associated with the type of rehabilitation modality instituted. Data was analysed and results presented as frequencies and percentages. RESULTS: Out of the 47 cases of maxillectomy recorded in the department during the study period, 44 cases met the criteria for inclusion, while 3 cases were excluded due to missing records. There were 21(47.7%) males and 23(52.3%) females with a male to female ratio of 1:1,015. The minimum age was 1 and the maximum age was 73 years, with the mean age of 36.1(16.3). Majority of patients were in the age group of 41-60 years. The most indications for maxillectomy were pathological lesions (90.9%), with a nearly equivalent distribution of 19 (47.5%) benign and 21 (52.5%) malignant lesions. Ossifying fibroma (26.32%) was the most common benign lesions and squamous cell carcinoma (33.33%) was the most common malignant lesions. Trauma constituted only 9.1%. Brown’s classification type IIB (38.6%) was the most common defect following maxillectomy procedure. The prosthetic obturator was used as a sole rehabilitative modality in most (47.75%) of the patients. Vascularised free tissue transfers were associated with more complications. CONCLUSION: Prosthetic obturator as a sole rehabilitative modality still plays an important role in the rehabilitation of patients with maxillectomy. The findings of this study should serve as the basis for future treatment algorithm for maxillectomy in the department.