TY - JOUR
T1 - Sinonasal Issues After Maxillectomy With Free Flap Reconstruction
T2 - Incidence and Clinical Approach
AU - Lerner, David K.
AU - Filimonov, Andrey
AU - Filip, Peter
AU - Liu, Katherine
AU - Russell, Stephen
AU - Shah, Janki
AU - Spock, Todd
AU - Schaberg, Madeleine
AU - Del Signore, Anthony
AU - Colley, Patrick
AU - Govindaraj, Satish
AU - Khan, Mohemmed Nazir
AU - Iloreta, Alfred Marc
N1 - Publisher Copyright:
© 2021 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2022/1
Y1 - 2022/1
N2 - Objective: To characterize the clinical features associated with sinonasal complaints after maxillectomy with free flap reconstruction as well as propose a screening and treatment algorithm. Methods: Retrospective review of patients who underwent maxillectomy and free flap reconstruction at a tertiary care center. Results: Fifty-eight patients were included, 25 (43.1%) of them had documented sinonasal complaints postoperatively. Eleven patients subsequently underwent revision surgery for sinonasal complaints. Among the 25 patients with sinonasal complaints, 22 patients (88.0%) had nasal crusting, 17 (68.0%) had nasal obstruction, 12 (48.0%) had rhinorrhea, 9 (36.0%) had facial pain or pressure, and 7 (28.0%) had foul odor. Twenty-two patients (88.0%) had multiple sinonasal complaints. There was a higher incidence of both sinonasal complaints and surgical intervention in patients who underwent adjuvant radiation, but this was not statistically significant (47.7% vs 28.6%, P =.235; 29.4% vs 7.1%, P =.265). Conclusions: Sinonasal complaints are common following free flap reconstruction for a maxillectomy defect and should be screened for at postoperative visits, with early referral to a rhinologist for consideration of endoscopic sinus surgery. Nonsurgical treatment strategies include large-volume nasal saline irrigations, xylitol irrigations for persistent inflammatory symptoms, and culture-directed antibiotic irrigations for persistent infectious symptoms. Level of Evidence: 4 Laryngoscope, 132:67–72, 2022.
AB - Objective: To characterize the clinical features associated with sinonasal complaints after maxillectomy with free flap reconstruction as well as propose a screening and treatment algorithm. Methods: Retrospective review of patients who underwent maxillectomy and free flap reconstruction at a tertiary care center. Results: Fifty-eight patients were included, 25 (43.1%) of them had documented sinonasal complaints postoperatively. Eleven patients subsequently underwent revision surgery for sinonasal complaints. Among the 25 patients with sinonasal complaints, 22 patients (88.0%) had nasal crusting, 17 (68.0%) had nasal obstruction, 12 (48.0%) had rhinorrhea, 9 (36.0%) had facial pain or pressure, and 7 (28.0%) had foul odor. Twenty-two patients (88.0%) had multiple sinonasal complaints. There was a higher incidence of both sinonasal complaints and surgical intervention in patients who underwent adjuvant radiation, but this was not statistically significant (47.7% vs 28.6%, P =.235; 29.4% vs 7.1%, P =.265). Conclusions: Sinonasal complaints are common following free flap reconstruction for a maxillectomy defect and should be screened for at postoperative visits, with early referral to a rhinologist for consideration of endoscopic sinus surgery. Nonsurgical treatment strategies include large-volume nasal saline irrigations, xylitol irrigations for persistent inflammatory symptoms, and culture-directed antibiotic irrigations for persistent infectious symptoms. Level of Evidence: 4 Laryngoscope, 132:67–72, 2022.
KW - Maxillectomy
KW - endoscopic surgical procedure
KW - free flap reconstruction
KW - quality of life
KW - sinusitis
UR - http://www.scopus.com/inward/record.url?scp=85108947170&partnerID=8YFLogxK
U2 - 10.1002/lary.29718
DO - 10.1002/lary.29718
M3 - Article
C2 - 34191297
AN - SCOPUS:85108947170
SN - 0023-852X
VL - 132
SP - 67
EP - 72
JO - Laryngoscope
JF - Laryngoscope
IS - 1
ER -