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Ophthalmic Changes Following Maxillectomy With or Without Postoperative Radiation Therapy

Sweeney, Adam R., MD*; Walker, Brian, BS; Bhrany, Amit D., MD; Chang, Shu-Hong, MD*; Jian-Amadi, Arash, MD*

doi: 10.1097/SCS.0000000000005437
Original Article: PDF Only

Purpose: To evaluate ophthalmic complications and quantitatively assess anatomic changes following maxillectomy with or without adjuvant radiotherapy in patients with midface malignancy.

Methods: Twenty-four patients who underwent maxillectomy for sinus and/or paranasal cancer were included for retrospective review. Patients with complete ophthalmic examinations were evaluated for postoperative findings corresponding to sequelae of treatment. When available, anatomical changes including eyelid position were quantified from preoperative and postoperative full-face photos using computer software.

Results: The most common complications identified in patients after maxillectomy were retraction/ectropion (50%), epiphora (29%), and exposure keratopathy/dry eye syndrome (25%). Patients treated with maxillectomy with adjuvant radiation therapy were more frequently found to have ophthalmic complications following treatment. In patients with available postoperative photos (n = 10), the mean ipsilateral margin reflex distance (MRD)2 and inferior scleral show were 8.4 mm and 2.4 mm, respectively. In patients with available preoperative photos (n = 5), the mean change in MRD2 and inferior scleral show following maxillectomy was 3.4 mm and 2.8 mm, respectively.

Conclusion: Patients undergoing maxillectomy for the treatment of head and neck malignancy may be at significant risk for development of specific periocular complications. Lower eyelid malposition was the most significant postoperative quantitative eyelid change following maxillectomy, which may be exacerbated by adjuvant radiotherapy and inferior orbital rim removal.

*Department of Ophthalmology, Division of Oculoplastic Surgery

University of Washington School of Medicine

Department of Otolaryngology—Head and Neck Surgery, University of Washington, Seattle, WA.

Address correspondence and reprint requests to Adam R. Sweeney, MD, Department of Ophthalmology, University of Washington, Box 359608, 325 Ninth Ave, Seattle, WA 98104-2499; E-mail:

Received 25 September, 2018

Accepted 28 January, 2019

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.