Patterns of Recurrence and Oncologic Outcomes After Maxillectomy: Does Reconstructive Modality Matter?

[BACKGROUND] Reconstruction following maxillectomy for oral cavity malignancies is essential for restoring form and function. Obturator reconstruction facilitates direct visualization of the surgical bed, whereas flap-based reconstructions may obscure sites of potential recurrence. This has raised concern that reconstructive modality could influence the timeliness of recurrence detection, and subsequently, oncologic outcomes.

[PURPOSE] The purpose of this study was to measure the association between reconstructive modality and time to detection of local recurrence and survival outcomes.

[STUDY DESIGN, SETTING SAMPLE] This was a retrospective cohort study of all patients undergoing maxillectomy for an oral cavity malignancy at the University of Maryland between 2016 and 2024. Patients previously undergoing maxillectomy were excluded.

[PREDICTOR VARIABLE] The predictor was reconstructive modality: obturator versus native tissue reconstruction (local, regional, or free flap).

[MAIN OUTCOME VARIABLE] The primary outcome was local disease-free survival. Secondary outcomes included overall survival, method of recurrence detection (clinical vs radiographic), and resectability of recurrence.

[COVARIATES] Covariates were categorized into demographic (age, sex), perioperative (Brown classification), and pathologic (margin status, tumor stage).

[ANALYSES] Descriptive statistics were computed for study variables. Associations between study covariates and time to local recurrence were evaluated using bivariate Cox proportional hazards models.

[RESULTS] The cohort was composed of 154 subjects with a mean age of 66.5 ± 14.9 years and 90 were male (58.4%). Fifty subjects (32.5%) underwent obturator reconstruction and 104 (67.5%) underwent reconstruction with native tissue (75% free flap). Reconstructive modality was not associated with local disease-free survival (P = .9), method of detection (P = .4), or overall survival (P = .3). Local recurrence occurred in 41 subjects (26.6%), with 14 (34.1%) in the obturator group compared to 27 (65.9%) in native tissue (P = .7). The median time to local recurrence was 7.7 months (interquartile range 26.2 months). Most recurrences (75.6%) were detected clinically. Subgroup analysis of Brown 2 defects confirmed the similar findings.

[CONCLUSIONS AND RELEVANCE] Reconstructive modality was not associated with delayed detection of local recurrence or worse survival outcomes following maxillectomy for oral cavity malignancies.