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Head and Neck Surgery

Margin Status in Maxillectomy for Malignancy: Implications for Reconstructive Planning

Sunday, October 1, 2023
1:06 PM - 1:12 PM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Katerina Jane Green, MB BCh BAO

    PGY-1 Resident
    Mayo Clinic - Jacksonville
    Jacksonville, FL, United States

    • Co-Author(s)

  • Katerina Jane Green, MB BCh BAO

    PGY-1 Resident
    Mayo Clinic - Jacksonville
    Jacksonville, FL, United States

  • TC

    Tracy Z. Cheng, MD, MHS

    Resident
    University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

  • NF

    Neil B. Fadia, BS

    Research Fellow
    University of Pittsburgh Medical Center
    Pittsburgh, Pennsylvania, United States

  • SS

    Shaum S. Sridharan, MD

    Assistant Professor, Department of Otolaryngology and Plastic & Reconstructive Surgery
    Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center
    Pittsburgh, PA, United States

  • MS

    Mario G. Solari, MD

    Chief, H&N Reconstruction and Craniofacial Trauma
    University of Pittsburgh Medical Center, Department of Plastic Surgery
    Pittsburgh, PA, United States

    • Senior Author(s)

  • MK

    Mark W. Kubik, MD

    Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh School of Medicine, USA

Disclosure(s):
Neil Fadia, BS: No relevant relationships to disclose.
Introduction: Debate surrounds immediate versus delayed microvascular reconstruction after maxillectomy due to concern for high rates of positive intraoperative frozen section margins. Staged reconstruction with virtual surgical planning may increase margin clearance and accuracy of reconstruction but has the potential to delay care. This study reviews margin status after maxillectomy across a range of histologies to further inform this decision.

Methods: This was a single institution retrospective study of all patients who underwent maxillectomy with reconstruction for a malignant diagnosis from 2013-2021. Primary outcomes of interest were histopathological type, final margin status, rates of re-excision of positive intraoperative, and final margin status.

Results: 80 patients met the inclusion criteria. 54% were male, and average age was 58 years. The most common diagnosis was squamous cell carcinoma (SCC) (n=48, 60%), and the most common procedure was infrastructure maxillectomy (n=44, 55%). Intraoperative frozen section pathology was obtained for 84% of patients (n=67), 60% of which were positive intraoperatively (n=40). 33 patients of patients had positive margins on final pathology (41%). 11 patients with SCC had positive final margins (18%) which was a significantly lower rate than other histopathological types (p=0.000). 82% of positive SCC margins were considered unresectable nerve or skull base margins (n=9). There were 2 positive bone or mucosal margins of all SCCs (4%) for which re-resection was possible. 52 patients had primary reconstruction and 28 patients underwent staged reconstruction 5-9 days after oncologic surgery (35%). 3/80 underwent margin re-excision at the time of staged reconstruction (4%).

Conclusions: Surgical maxillectomy is associated with high rates of intraoperative and final positive margins across several histologies. However, these margins were often skull base margins or associated with perineural invasion and thus not amenable to re-excision. Consequently, staging reconstruction to optimize margin clearance may not be beneficial and increase delays in adjuvant care.