Mary came to NCH in August 2010. She had a tumor of the maxilla that had been growing for years. At surgery, we found that the maxilla was completely destroyed by the tumor-medial, lateral, inferior walls were gone. The orbital floor was also gone and the eye was sitting on tumor. The zygomatic arch was partially destroyed. The pathology showed fibrous dysplasia/ossifying fibroma.
|After resection of the tumor|
As a result of the destruction of the maxilla, the face "caved in" after surgery since there was no bony structures to support it. In addition, there was a large defect between the sinus and the oral cavity. Mary also had difficulty closing her right eye. We performed a tarsorrhaphy which helped somewhat. Mary kept coming back for checkups and this trip we decided to do some corrective surgery.
We raised a temporalis muscle flap and placed it into the sinus cavity. This filled the facial defect as well as the defect between the sinus and the oral cavity.
The initial results are good but we will see how things look after the swelling decreases. We may need to place a support under the eye to rebuild the orbital floor.
|Incision for temporalis flap|
|Flap raised off skull|
|Flap placed in sinus cavity|
|Results after 1 week|