LAPORAN KASUS DIVISI

BEDAH KEPALA LEHER

YIPNO WANHAR
Ny. W/ P/ 63 thn/ 12651933/Bone Tumor Maxilla S

Regio Facialis
Hasil CT Scan Kepala (06-02-2018):
- Tampak massa tumor tulang yang berasal dari os maxilla kiri
yang meluas ke orbita kiri berbatas tegas, tepi rata dengan
calsifikasi didalamnya yang pada pemberian contras tampak
penyangatan.
- Midline shift (-)
- Tak tampak kelainan intra cranial
Kesan : Bone Tumor yang berasal dari os maxilla sinistra, curiga benigna.

Hasil Foto Thorax (11-02-2018):

Cor dan pulmo tidak tampak kelainan, metastase (-)

Hasil Patologi Anatomi FNAB (19-02-2018):

Dilakukan 4 kali puncture pada massa regio maxilla sinistra, ukuran 15x12x10 cm, fixed, batas tegas,
konsistensi padat keras. Jarum terbentur tulang.
Saran: open biopsi
 Ny. Wagira /P/ 63 thn/12651933 Rabu, 2-5-2018
Identitas
MRS : 19-4-2018 DPJP : dr. DAS, Sp.B(K)Onk-KL
Diagnosa
Bone tumor maxilla sinistra
Pre-Op
Tindakan Trakeostomi + Total hemimaksilektomi sinistra + rekontruksi

Deskripsi • Didapatkan :
- Tumor maxilla ukuran 16x10x7 cm, keras, berat 700 g

• Dilakukan
- Tracheostomy
- Insisi Weber ferguson
- Total Maksilektomi dengan memotong rima orbita lateral S, os nasal S sampai prosesus frontalis, os maxilla S, palatum S
sampai caninus maxilla D dan Arcus zygoma S
- Tumor maxilla diangkat dengan sebagian os nasal, dasar orbita, os zygoma S dan palatum
- Rawat perdarahan
- Rekontruksi defek dilanjutkan TS Plastik —> Orbital floor dengan titanium mesh, rima orbita dengan bone & palatum dennen
bucal flap

Diagnosa Bone tumor maxilla sinistra

Post-Op
Dr. SHE, SpB/dr. TUR, SpB/FLO
Operator
 Pre Op

Post Op
 Durante Op
Cranial Bedah KL

Massa
Tumor

Caudal

Regio Facialis
Wagira/ P/ 63 thn/ 12651933/ Bedah Edelweiss/ 02-05-18
Durante op
Bedah Plastik

Rekonstruksi Rima
Orbita Inferior –
Frontozygoma – dan
Orbital Floor Sinistra
dengan cartilage bone
graft

Regio Facialis
Regio Facialis
How to Reconstruction The Defect ???
Introduction
The maxillary bone is important both for aesthesis of the face and function of the oral cavity

The defects of maxilla affect the speech, swallowing and mastication

Rehabilitation —> Obturator prosthesis OR Surgical reconstruction

Andrades, P et al. Several articles describe speech outcomes associated with prosthetic rehabilitation
—> prosthetic intervention leads to a restoration of dentition, reduction of hypernasality
Kornblith et al. observed that patients with more than a third of the soft palate and a fourth of the
hard palate resected had poor speech scores and overall obturator function
Okay et al. Concluded that the defects that involved more than half the hard palate or included the
premaxilla and both canines were poor candidates for prosthetic reconstruction
The superiority of free flaps in improving the quality of life even in small and medium defects of
maxilla was reported by Genden et al
Pittman AL, Zender CA. Total maxillectomy. Operative Techniques in Otolaryngology (2010) 21, 166-170
 Cordeiro & Chen classification (2012)
Tipe Nama Tindakan
I Limited maxillectomy Reseksi 1 atau 2 dinding maksila, kecuali palatum
II Subtotal maxillectomy Reseksi arkus, palatum, dinding anterior,
posterior, medial, dan lateral, dengan preservasi
orbital floor
III Total maxillectomy Reseksi 6 dinding maksila
IIIa Preservasi isi orbita
IIIb Eksenterasi isi orbita
IV Orbitomaxillectomy Eksenterasi isi orbita dan 5 dinding maksila,
preservasi palatum
 Brown’s classification (2010)

Bell, RB, dkk. Oral, Head and Neck Oncology and Reconstructive Surgery. Oregon: Elsevier. 2018
PROSTHETIC REHABILITATION —> Surgical obturator

The best candidate for prosthetic rehabilitation would be a

patient who has not undergone radiation and with a small
lateral or posterior palatomaxillary defect and viable
dentition to support prosthesis
Benefits of rehabilitation with an obturator outside of the functional
realm also include the ability to visualize the defect for ongoing
cancer surveillance
SOFT-TISSUE FREE-FLAP RECONSTRUCTION —> Temporalis Musculofascial rotational flap

Reconstruction with soft-tissue–only flaps may be indicated in 2

settings: small- to medium-sized lower maxillectomy defects with
viable dentition to support prosthesis & extensive defects in patients
with relatively poor oncologic prognosis
 OSTEOCUTANEOUS FREE-FLAP RECONSTRUCTION —> Osteocutaneous radial forearm (OCRF), fibula, iliac
crest, and the subscapular system of flaps

Bone reconstruction should be considered in medium-sized to large

maxillectomy defects, with good oncologic prognosis

Vascularized bone flaps are often needed to restore midfacial height, width, and projection, as well as to provide adequate bone stock for
mastication and osseointegrated implants, which are usually required for the fixation of dental prostheses
RECONSTRUCTION OF COMPLEX DEFECTS

Defects that include cheek skin, orbital, and/or the external nose —> increase the
complexity of maxillary reconstruction floor
Reconstructive flap with grafts, implants, or even prostheses may be
indicated