Kee Tae Eun, Joo Chan Woong, Lee Won Sup, Kim Kyoung Lae, Na Kyeong Ik, Kim Yong-Kyu, Park Sung Pyo, Choi Youn Joo
Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
Yonsei Cho Eye Clinic, Chuncheon, South Korea.
Heliyon. 2024 Oct 5;10(19):e38861. doi: 10.1016/j.heliyon.2024.e38861. eCollection 2024 Oct 15.
Maxillectomy, a critical surgical intervention for head and neck malignancies, often leads to a comprehensive spectrum of ophthalmic complications due to its impact on orbital structures. This study, conducted over 20 years at a single university hospital, aims to evaluate the extent and severity of these complications, encompassing the entire range of ophthalmological issues encountered in the field.
A retrospective, observational cohort study.
Among the 163 patients who underwent maxillectomy at a single university hospital between January 2003 and December 2022, we analyzed the medical records of 101 patients with over one year of postoperative ophthalmological follow-up. Data on demographics, clinical parameters, surgical details, and ophthalmic complications were collected. Complications were categorized into six groups, with statistical analysis identifying factors influencing these outcomes.
Our findings reveal a predominant occurrence of ophthalmic complications among maxillectomy patients. Only 4.4 % had no complications, while 95.6 % experienced at least one, especially with cornea/conjunctiva (56 %), eyelid (48.4 %), and lacrimal system issues (38.5 %) being the most frequent. Notably, 64.8 % had complications in two or more categories, and 33 % in three or more. Multivariate analysis identified that orbital floor resection was a significant risk factor for complications involving the eyelid and the cornea/conjunctiva ( = 0.008 and = 0.021, respectively), while radiotherapy specifically emerged as a significant risk factor for cornea/conjunctiva complications ( = 0.009). Surgical management of complications following maxillectomy often involved major tissue transplantation in plastic surgery, particularly for cases of significant tissue contraction or severe orbital dystopia. Common secondary ophthalmic surgeries included dacryocystorhinostomy (DCR) in 14 eyes, tarsorrhaphy in 12 eyes, and lateral tarsal strip procedures in 5 eyes. The study found a high incidence of multiple complications, highlighting the complex nature of postoperative challenges.
Maxillectomy patients are highly susceptible to a range of ophthalmological complications, primarily influenced by surgical extent and adjuvant therapies. A multidisciplinary approach is essential for comprehensive management and improved quality of life in these patients. The study underscores the need for thorough ophthalmological evaluation and integrated care in treating maxillectomy-related complications.
上颌骨切除术是头颈部恶性肿瘤的一项关键手术干预措施，由于其对眼眶结构的影响，常常会引发一系列广泛的眼科并发症。本研究在一家大学医院开展了20年，旨在评估这些并发症的范围和严重程度，涵盖该领域遇到的所有眼科问题。
一项回顾性观察队列研究。
在2003年1月至2022年12月期间于一家大学医院接受上颌骨切除术的163例患者中，我们分析了101例术后接受眼科随访超过一年的患者的病历。收集了人口统计学、临床参数、手术细节和眼科并发症的数据。并发症分为六组，通过统计分析确定影响这些结果的因素。
我们的研究结果显示上颌骨切除术患者中眼科并发症发生率很高。只有4.4%的患者没有并发症，而95.6%的患者至少出现一种并发症，其中角膜/结膜（56%）、眼睑（48.4%）和泪道系统问题（38.5%）最为常见。值得注意的是，64.8%的患者有两类或更多类别的并发症，33%的患者有三类或更多类别的并发症。多变量分析确定，眶底切除术是涉及眼睑和角膜/结膜并发症的一个重要危险因素（分别为P = 0.008和P = 0.021），而放疗尤其成为角膜/结膜并发症的一个重要危险因素（P = 0.009）。上颌骨切除术后并发症的外科处理通常涉及整形外科中的大型组织移植，特别是对于有明显组织收缩或严重眼眶发育异常的病例。常见的二期眼科手术包括14只眼的泪囊鼻腔吻合术（DCR）、12只眼的睑裂缝合术和5只眼的外侧睑板条手术。该研究发现多种并发症的发生率很高，突出了术后挑战的复杂性。
上颌骨切除术患者极易出现一系列眼科并发症，主要受手术范围和辅助治疗的影响。多学科方法对于这些患者的综合管理和改善生活质量至关重要。该研究强调在治疗上颌骨切除术相关并发症时需要进行全面的眼科评估和综合护理。
