Orbital Plate Preserving Maxillectomy Guidelines

Preoperative Planning

The American College of Surgeons recommends obtaining cone beam CT or conventional CT extended to the orbit to visualize the osteomeatal complex, identify sinus septa, and assess anatomical variations that will impact surgical approach, with a prevalence of sinus septa in ~30% of patients 3, 1
The American Academy of Otolaryngology recommends requesting otorhinolaryngology consultation if the patient has any history of sinusitis, nasal obstruction, chronic respiratory disease, or radiologic evidence of mucosal thickening >3mm with osteomeatal complex closure 3, 1
The American Society for Radiation Oncology recommends reviewing radiation therapy plans if the patient has prior head and neck radiation, paying particular attention to cumulative dose to the maxilla, as doses ≥50 Gy significantly increase osteoradionecrosis (ORN) risk 4, 5, 6

The American College of Surgeons recommends performing en bloc resection whenever technically feasible with clear margins of at least 1.5-2 cm of visible and palpable normal mucosa 1
The American Academy of Otolaryngology recommends obtaining frozen section margin assessment intraoperatively to ensure complete tumor removal and avoid the need for re-resection 1

The American Society of Plastic Surgeons recommends using fibula or scapula osteocutaneous free flaps for full thickness defects requiring both structural support and soft tissue coverage, with 92% success rates and only 4% total flap loss 7, 2
The American College of Surgeons recommends using rectus abdominis myocutaneous free flap for soft tissue reconstruction and palatal resurfacing when bone reconstruction is not required, achieving good functional outcomes with 85.7% usage rate in one series 7

The American Pain Society recommends prescribing NSAIDs (ibuprofen 600mg TID) or acetaminophen 500mg TID for pain control 1
The American College of Surgeons recommends continuing broad-spectrum antibiotics for 7-10 days postoperatively 1, 7

The American Society for Radiation Oncology recommends maintaining pentoxifylline/tocopherol therapy throughout the healing period in previously radiated patients 4, 5, 6
The American College of Radiology recommends routine prophylactic hyperbaric oxygen is not recommended for standard maxillectomy procedures 4, 5