Reconstruction chirurgicale des pertes de substance des maxillaires

Maxillary defects are a complex problem due to many factors such as anatomical specific aspects in the maxillary area, multiple pathological conditions, variability of the aetiologies, the very large panel of surgical techniques, and the poor knowledge on their effective functional results. Theses considerations have led to a lack of consensus. Thus, it was necessary to review a large number of published works in order to try to draw some schematic rules with the help of personal experience. Regarding well-known anatomical data, defining a new classification seems desirable, obviously taking into account those previously presented but more likely to help in the choice of the right procedure. Keeping in mind the aetiological and functional considerations, such a classification is presented, based on horizontal and vertical osseous structural columns of the face that have to be reconstructed. The various surgical techniques are presented, together with a critical and comparative analysis for each type of defect. Finally, we discuss some controversial points such as the interest of prosthetic appliances, particular considerations in carcinology and the real functional results of surgical maxillary reconstructions. All these aspects make very difficult proposing a rigid decisional tree. Obviously, this complex subject needs further studies; benefits are expected from future technical advances.