Maxillectomy Procedures and Surgical Approaches

Anatomical Considerations

The National Comprehensive Cancer Network recommends using "Ohngren's line" to define the plane through the maxillary sinus for tumor classification, with tumors "below" or "before" this line involving the maxillary infrastructure and tumors "above" or "behind" this line involving the suprastructure 1, 2

The National Comprehensive Cancer Network suggests that en bloc resection of the primary tumor should be attempted whenever feasible, with in-continuity neck dissection necessary when there is direct extension of the primary tumor into the neck 1, 2
Surgical resection should be planned based on clinical examination and careful interpretation of appropriate radiographic images, with frozen section margin assessment considered when it will facilitate complete tumor removal 1, 2
Adequate resection is defined as clear margins with at least 1.5-2 cm of visible and palpable normal mucosa 1, 2

Schneiderian membrane perforation is the most common intraoperative complication during sinus procedures, occurring in 19.5% of cases 3
Postoperative complications may include abnormal bleeding, infections, and subacute sinusitis 4
Retained secretions in the maxillary sinus may require removal during follow-up endoscopy, and synechiae may occur postoperatively, potentially requiring revision surgery 5