Malignant growth maxilla

A case of malignant growth right maxilla advanced stage.

This case is being presented to discuss the role of palliative surgery.

Clinical details:

70 years old male came with complaints of:

Nasal block (right side) - 1 1/2 years duration
Foul smelling discharge from right nose - 1 year
Swelling right side of cheek - 1 year duration
Swelling under right lower lip - 6 months

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Clinical photograph of the patient showing right cheek swelling and discharge from right nasal cavity

On examination:

Swelling ++ involving the right maxilla.
Destruction of antero lateral wall of right maxilla ++
Swelling was variable in consistency.
Bony crepitus felt in some areas of anterior wall of maxilla
Vision was normal in the left eye

Nose:

Foul smelling discharge from right nasal cavity ++
Proliferative mass seen filling the right nasal cavity completely

Intra-oral examination:

Proliferative mass seen involving the bucco gingival sulcus on the right side
Loss of upper dentition on the right side. Edentulous.

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Photograph showing growth maxilla

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Photograph showing growth right maxilla in its entirity

Imaging:

CT scan both axial and coronal sections were performed.

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CT plain maxilla axial cut showing growth right maxilla eroding anterolateral wall

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CT plain nose and paranasal sinuses coronal cut showing mass inside the right maxilla with erosion of palate

Review of Scan images showed:

Extensive growth involving the right maxillary sinus with erosion of its anterolateral, medial and posterior walls.
Lateral pterygoid process was found to be eroded as well.

Management:

Optimal management modality in patients with advanced malignancies is to alleviate the acute symptoms of the
disease. In this patient by debulking the mass and following it up with post op irradiation palliation could be
achieved to a certain extent.

Ideal surgical management in this patient:

Total maxillectomy right with total removal of palate.

The patient was taken up for surgery i.e. total maxillectomy combined with total excision of hard palate.
Temporary obturator was used to fill up the defect caused by removal of right maxilla.

Surgical steps:

General anesthesia was used.
Tracheostomy was performed

Weber Ferguson incision was used to expose the right maxilla

incision.JPG

Figure showing Weber Ferguson incison marked

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Photo showing the patient after removal of maxilla

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Photo showing gutta percha prosthesis in positions after maxillectomy

6 weeks after surgery irradiation was started.

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