How i do it: Head and neck and plastic surgery: Maxillary removal and reinsertion for improved access to anterior cranial base tumors



Portions or all of the maxillae are oftentimes removed solely to provide access to certain cranial base tumors rather than because they are involved directly with disease. The purpose of this report is to describe an approach that involves removal of one or both maxillae to improve tumor exposure with subsequent reinsertion as free bone grafts which are stabilized with titanium craniofacial fixation plates. The titanium permits postoperative imaging studies and radiotherapy. Eleven patients ranging from 10 to 69 years of age have undergone 12 operations using this technique for resection of 4 benign and 8 malignant tumors at The Ohio State University. Seven of the 8 patients with malignancies underwent postoperative radiation therapy. There have been no permanent complications and no evidence of bone resorption in this group after follow-up of up to 15 months.