| Oncologic Outcomes of Prosthetic Obturator Compared with Free Flap Reconstruction after Maxillectomy for Maxillary Sinus Malignancies |
Young-Ha Lee
, Sung Seok Ryu
, Kyung Won Kwon
, Ji Heui Kim
, Yoo-Sam Chung
, Myeong Sang Yu
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| Department of Otorhinolaryngology-Head and Neck surgery, University of Ulsan College of Medicine, Asan Medical Center |
| Correspondence |
Myeong Sang Yu ,Tel: +82-2-3010-3710, Fax: +82-2-489-2773, Email: dryums@gmail.com
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Received: September 18, 2025; Revised: January 12, 2026 Accepted: February 4, 2026. Published online: February 5, 2026.
*Young-Ha Lee and Sung Seok Ryu contributed equally to this work. |
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| ABSTRACT |
Objectives
Obturator and free flap reconstruction differ in their postoperative visibility, potentially affecting cancer surveillance. This study compared clinicopathologic and survival outcomes after maxillectomy in patients with maxillary sinus malignancies and evaluated overall survival (OS) and disease-free survival (DFS) in both the overall cohort and a squamous cell carcinoma (SCC) subgroup.
Methods
A retrospective review of 61 patients (41 obturator, 20 free flap) who underwent maxillectomy between 2002 and 2021 was performed. Clinicopathologic features, resection margin status (clear, close, positive), recurrence patterns, and survival outcomes were analyzed. OS and DFS were estimated using Kaplan–Meier methods, and multivariable Cox models included reconstruction method, overall stage, resection margin status, and postoperative adjuvant therapy in the entire cohort and the SCC subgroup.
Results
Patients in the obturator group were older (63.7 vs. 54.1 years, P=0.046) and more often underwent total maxillectomy (80.5% vs. 50.0%, P=0.039). SCC was the most frequent histology (80.5% vs. 65%). OS and DFS did not differ significantly between groups: 2- and 5-year DFS were 56.1% and 44.1% (obturator) vs. 44.1% and 33.1% (free flap; P=0.931); 2- and 5-year OS were 68.0% and 50.0% vs. 77.1% and 44.1%, respectively (P=0.990). Among 46 patients with SCC (33 obturator, 13 free flap), survival outcomes were comparable. In multivariable analyses, close and positive margins and absence of postoperative adjuvant therapy were independently associated with poorer OS and DFS, whereas reconstruction method was not. Local recurrence was the most common failure pattern in both groups.
Conclusion
Obturator and free flap reconstruction showed comparable survival after maxillectomy for maxillary sinus malignancies. Resection margin status and postoperative adjuvant therapy were the major prognostic factors, underscoring individualized reconstruction and the importance of adequate margins, appropriate adjuvant treatment, and consistent follow-up. |
| Keywords:
Maxillary sinus neoplasms, Maxillectomy, Squamous cell carcinoma of head and neck, Palatal obturators, Surgical flaps, Survival analysis |
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