Evaluation of Mucociliary Activity in Maxillary Antra in Patients with Squamous Cell Carcinoma of Buccal Mucosa Undergoing Post Operative Radiotherapy

Kadapathri, Abhimanyu; Mohiyuddin, S. M. Azeem

doi:10.1007/s12070-018-1477-2

Cited by 1 publication

(4 citation statements)

References 13 publications

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“…Lastly, the mucociliary function of the remaining respiratory sinonasal mucosa is severely impaired in patients who undergo adjuvant radiation. 6,10,[13][14][15] Despite awareness of sinonasal complications in this population anecdotally, there is a paucity of literature regarding prevalence and potential treatment options.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, native respiratory epithelium of the nasal cavity is replaced by the nonciliated squamous epithelium lining the reconstruction, disrupting normal air flow and mucociliary clearance. Lastly, the mucociliary function of the remaining respiratory sinonasal mucosa is severely impaired in patients who undergo adjuvant radiation 6,10,13–15 . Despite awareness of sinonasal complications in this population anecdotally, there is a paucity of literature regarding prevalence and potential treatment options.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who undergo maxillectomy with free flap reconstruction with or without adjuvant radiation often complain of sinonasal symptoms including nasal obstruction, crusting, rhinorrhea, foul odor, and facial pain or pressure. Similar complaints have been well documented in the nasopharyngeal carcinoma literature as a consequence of targeted radiotherapy, but have not been well described for patients who underwent surgical reconstruction with or without radiation 6–15 . For patients with radiation‐induced sinusitis alone, endoscopic sinus surgery has been found to be effective, whereas treatment with a topical nasal saline and steroid sprays has been considered to be less effective given the damaged nasal mucosa 8–10 .…”

Section: Introductionmentioning

confidence: 88%

“…Similar complaints have been well documented in the nasopharyngeal carcinoma literature as a consequence of targeted radiotherapy, but have not been well described for patients who underwent surgical reconstruction with or without radiation. [6][7][8][9][10][11][12][13][14][15] For patients with radiation-induced sinusitis alone, endoscopic sinus surgery has been found to be effective, whereas treatment with a topical nasal saline and steroid sprays has been considered to be less effective given the damaged nasal mucosa. [8][9][10] Regardless of radiation status, patients who undergo midface reconstruction have additional deficits in mucociliary clearance secondary to both anatomic obstruction from free flap bulk as well as nonciliated squamous epithelium for nasal cavity lining.…”

Section: Introductionmentioning

confidence: 99%

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Sinonasal Issues After Maxillectomy With Free Flap Reconstruction: Incidence and Clinical Approach

et al. 2021

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Objective: To characterize the clinical features associated with sinonasal complaints after maxillectomy with free flap reconstruction as well as propose a screening and treatment algorithm.Methods: Retrospective review of patients who underwent maxillectomy and free flap reconstruction at a tertiary care center.Results: Fifty-eight patients were included, 25 (43.1%) of them had documented sinonasal complaints postoperatively. Eleven patients subsequently underwent revision surgery for sinonasal complaints. Among the 25 patients with sinonasal complaints, 22 patients (88.0%) had nasal crusting, 17 (68.0%) had nasal obstruction, 12 (48.0%) had rhinorrhea, 9 (36.0%) had facial pain or pressure, and 7 (28.0%) had foul odor. Twenty-two patients (88.0%) had multiple sinonasal complaints. There was a higher incidence of both sinonasal complaints and surgical intervention in patients who underwent adjuvant radiation, but this was not statistically significant (47.7% vs 28.6%, P = .235; 29.4% vs 7.1%, P = .265).Conclusions: Sinonasal complaints are common following free flap reconstruction for a maxillectomy defect and should be screened for at postoperative visits, with early referral to a rhinologist for consideration of endoscopic sinus surgery. Nonsurgical treatment strategies include large-volume nasal saline irrigations, xylitol irrigations for persistent inflammatory symptoms, and culture-directed antibiotic irrigations for persistent infectious symptoms.

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