31230 Maxillectomy; with orbital exenteration (en bloc)

Name of the Procedure:

Maxillectomy with Orbital Exenteration (En Bloc)

Summary

A maxillectomy with orbital exenteration is a surgical procedure that involves the removal of part or all of the maxilla (upper jaw bone) along with the contents of the orbit (eye socket) in one combined operation. This procedure is often performed to treat aggressive cancers or tumors that affect both the upper jaw and the eye socket.

Purpose

The primary purpose of this procedure is to treat advanced-stage cancer or aggressive tumors that involve the maxilla and the eye socket. The goal is to remove the tumor entirely to prevent its spread and to improve the patient's prognosis.

Indications

• Malignant tumors of the maxilla that have spread to the orbit.
• Aggressive cancers that do not respond to other treatments.
• Recurrence of tumors in the maxilla and orbit after previous treatments.
• Symptoms such as facial swelling, pain, vision loss, or nasal obstruction.

Preparation

• Patients may be instructed to fast for 8-12 hours before surgery.
• Medication adjustments may be necessary, as advised by the doctor.
• Preoperative imaging studies, such as CT scans or MRIs, to assess the extent of the tumor.
• Blood tests and cardiovascular assessments may be conducted to ensure the patient is fit for surgery.

Procedure Description

1. The patient is placed under general anesthesia.
2. A surgical incision is made to provide access to the maxilla and orbit.
3. The surgeon removes the affected part or all of the maxilla along with the eye socket contents in one piece (en bloc).
4. Reconstruction of the facial structure may be performed using grafts or prosthetics.
5. The incision is closed with sutures.
6. The area is dressed, and a postoperative care plan is initiated.

Tools and equipment may include surgical scalpels, retractors, drilling instruments, and reconstructive materials.

Duration

The procedure typically takes around 4-6 hours, depending on the complexity and the extent of reconstruction required.

Setting

This procedure is performed in a hospital operating room under sterile conditions.

Personnel

• Head and neck surgeons
• Oculoplastic surgeons (if applicable)
• Surgical nurses
• Anesthesiologists
• Reconstructive surgeons (if needed)

Risks and Complications

• Infection
• Significant blood loss
• Nerve damage leading to facial numbness or weakness
• Complications from anesthesia
• Potential difficulty with chewing, speaking, or swallowing
• Loss of vision in the affected eye
• Cosmetic deformities
• Extended recovery time

Benefits

• Removal of aggressive or recurrent tumors, significantly improving chances of disease control.
• Relief from symptoms such as pain, swelling, and nasal obstruction.
• Prevention of further spread of the malignancy.

Recovery

• Postoperative care includes pain management, antibiotics to prevent infection, and wound care.
• Hospital stay may range from a few days to a week.
• Patients may have dietary restrictions initially and will need follow-up appointments for monitoring and potential reconstructive surgeries.
• Full recovery can take several weeks to months, depending on the extent of the surgery.

Alternatives

• Radiation therapy or chemotherapy (may be used in combination with or instead of surgery, depending on individual cases).
• Less extensive surgery if the tumor is smaller and more localized.
• Palliative care to manage symptoms without aggressive surgical intervention.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not experience pain. Postoperative discomfort is managed with pain medications. The patient may experience swelling, bruising, and discomfort in the surgical area, and vision loss in the affected eye. Emotional and psychological support may be necessary due to the significant changes in facial appearance and loss of an eye.