Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT, USA.
J Prosthet Dent. 2012 Apr;107(4):261-70. doi: 10.1016/S0022-3913(12)60071-7.
Maxillectomy defects are complex and involve a number of anatomic structures. Several maxillectomy defect classifications have been proposed with no universal acceptance among surgeons and prosthodontists. Established criteria for describing the maxillectomy defect are lacking.
This systematic review aimed to evaluate classification systems in the available literature, to provide a critical appraisal, and to identify the criteria necessary for a universal description of maxillectomy and midfacial defects.
An electronic search of the English language literature between the periods of 1974 and June 2011 was performed by using PubMed, Scopus, and Cochrane databases with predetermined inclusion criteria. Key terms included in the search were maxillectomy classification, maxillary resection classification, maxillary removal classification, maxillary reconstruction classification, midfacial defect classification, and midfacial reconstruction classification. This was supplemented by a manual search of selected journals. After application of predetermined exclusion criteria, the final list of articles was reviewed in-depth to provide a critical appraisal and identify criteria for a universal description of a maxillectomy defect.
The electronic database search yielded 261 titles. Systematic application of inclusion and exclusion criteria resulted in identification of 14 maxillectomy and midfacial defect classification systems. From these articles, 6 different criteria were identified as necessary for a universal description of a maxillectomy defect. Multiple deficiencies were noted in each classification system. Though most articles described the superior-inferior extent of the defect, only a small number of articles described the anterior-posterior and medial-lateral extent of the defect. Few articles listed dental status and soft palate involvement when describing maxillectomy defects.
No classification system has accurately described the maxillectomy defect, based on criteria that satisfy both surgical and prosthodontic needs. The 6 criteria identified in this systematic review for a universal description of a maxillectomy defect are: 1) dental status; 2) oroantral/nasal communication status; 3) soft palate and other contiguous structure involvement; 4) superior-inferior extent; 5) anterior-posterior extent; and 6) medial-lateral extent of the defect. A criteria-based description appears more objective and amenable for universal use than a classification-based description.
上颌骨切除术的缺损复杂，涉及多个解剖结构。已经提出了几种上颌骨切除术缺损分类方法，但外科医生和修复医生之间并没有普遍接受的分类方法。目前缺乏描述上颌骨切除术缺损的既定标准。
本系统评价旨在评估现有文献中的分类系统，进行批判性评估，并确定通用描述上颌骨切除术和中面部缺损所需的标准。
通过使用 PubMed、Scopus 和 Cochrane 数据库，对 1974 年至 2011 年 6 月期间的英文文献进行电子检索，并使用预定的纳入标准进行搜索。搜索中包含的关键词包括上颌骨切除术分类、上颌骨切除术分类、上颌骨切除分类、上颌骨重建分类、中面部缺损分类和中面部重建分类。这一检索方法通过对选定期刊的手动搜索进行了补充。应用预定的排除标准后，对最终的文章列表进行了深入审查，以提供批判性评估并确定通用描述上颌骨切除术缺损的标准。
电子数据库搜索产生了 261 个标题。系统地应用纳入和排除标准，确定了 14 种上颌骨和中面部缺损分类系统。从这些文章中，确定了 6 个不同的标准，这些标准是通用描述上颌骨切除术缺损所必需的。每个分类系统都存在多个缺陷。虽然大多数文章描述了缺损的上下范围，但只有少数文章描述了缺损的前后和内外范围。当描述上颌骨切除术缺损时，很少有文章列出了牙齿状况和软腭的受累情况。
没有任何分类系统能够根据满足手术和修复需求的标准准确描述上颌骨切除术的缺损。本系统评价中确定的用于通用描述上颌骨切除术缺损的 6 个标准是：1）牙齿状况；2）口鼻腔连通状态；3）软腭和其他相邻结构的受累情况；4）上下范围；5）前后范围；以及 6）缺损的内外范围。基于标准的描述比基于分类的描述更客观，更适合通用使用。
