Received: 6 February 2022 | Revised: 8 November 2022 | Accepted: 15 December 2022

DOI: 10.1002/cre2.708

REVIEW ARTICLE

Classification of maxillectomy in edentulous arch defects,

algorithm, concept, and proposal classifications: A review

Hatem Alqarni1,2 | Mohammed Alfaifi3 | Walaa Magdy Ahmed4 |

Rania Almutairi5 | Mathew T. Kattadiyil6

1
Department of Restorative and Prosthetic
Dental Sciences, College of Dentistry, King Abstract
Saud Bin Abdulaziz University for Health
Objectives: Aramany's classification of postsurgical maxillectomy defects was
Sciences, Riyadh, Saudi Arabia
2
King Abdullah International Medical Research
introduced for partially edentulous situations, and has been widely used for
Center, Riyadh, Saudi Arabia education and effective communication among practitioners. Numerous classifica-
3
Department of Prosthtic Dental Sciences, tions of maxillofacial defects, based on surgical procedure, resultant defects, or
King Khalid University College of Dentistry,
Abha, Saudi Arabia; Fellow in Advanced prosthodontist's perspective after rehabilitation, exist in the literature. However, no
Digital Prosthodontics and Implant Dentistry, single classification has incorporated all these factors. The purpose of this review
Department of Prosthodontics, Loma Linda
University School of Dentistry, Loma Linda, was to highlight the classification systems and describe a pragmatic classification
California, USA series for edentulous maxillary arch defects (maxillectomy) by applying the Aramany
4
Department of Restorative Dentistry, Faculty classification criteria, to enhance treatment outcomes and communication among
of Dentistry, King Abdulaziz University,
Jeddah, Saudi Arabia practitioners.
5
Prosthodontic Resident, King Saud Material and Methods: An electronic search of the literature published in English
University, Riyadh, Saudi Arabia
was conducted using the PubMed/MEDLINE and Google Scholar database.
6
Advanced Education Program in
Keywords used were “maxillectomy classification” AND “surgical resection,”
Prosthodontics, Loma Linda University School
of Dentistry, Loma Linda, California, USA “maxillectomy classification” AND “complete edentulous.” In addition, a manual
search was also performed followed the same criteria in the following journals:
Correspondence
Hatem Alqarni, Department of Restorative Journal of Prosthetic Dentistry and Journal of Prosthodontics.
and Prosthetic Dental Sciences, College of Results: Several classification systems for partial dentition were found in terms of
Dentistry, King Saud Bin Abdulaziz University
for Health Sciences, Prince Mutib Ibn Abdullah size, location, dentition, and extension of the defect (isolated or communication
Ibn Abdulaziz Rd, Ar Rimayah, 14611, defects). The findings revealed a variety of maxillectomy defect classifications for
Kingdom of Saudi Arabia.
Email: [email protected] partially dentate, considering surgical factors and rehabilitation. However, no study
or classification system exist for the edentulous arch defects.
Funding information
Conclusions: Different classification systems for maxillectomy defects exist in
None
the literature, only for partially dentate patients. To the authors best
knowledge, no classification system for completely edentulous maxillary arch
defects have been proposed till date. A simple classification system with clear
characteristics for edentulous maxillectomy dental arch defects has been
proposed. This classification was modeled after Aramany classification for
easier memorization and application.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2023 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.

Clin Exp Dent Res. 2023;9:45–54. wileyonlinelibrary.com/journal/cre2 | 45

46 | ALQARNI ET AL.

KEYWORDS
Armany, defect, maxillectomy, oncology

1 | INTRODUCTION
Clinical implication
Maxillectomy or maxillary resection is defined as the surgical removal This article reviews maxillectomy defect classifications
of part or all of the maxilla (The glossary of prosthodontic in the literature. A classification for maxillectomy defects
terms, 2017). The surgeon and the reconstructive team make of the edentulous arch was proposed using the concepts of
individualized decisions based on the size and extent of the defects. the Aramany classification.
Consequently, due to the complexity and three‐dimensional archi-
tecture of the maxilla, there have been several attempts to achieve a
unified classification system of midface post‐ablative defects.
Seventeen different classifications have been proposed in the past Luce, 1995; Yamamoto et al., 2004). The maxillectomy classifica-
half‐century (The glossary of prosthodontic terms, 2017). However, tion by Aramany was put forward for partially edentulous
none of the existing classifications concisely covers all possible patients which grouped particular combinations of teeth and
defects, which is essential for effective communication among surgical defects; and made it an effective tool for better
practitioner's to develop an appropriate treatment plan (Akinmoladun communication and development of appropriate framework
et al., 2013; Aramany, 1978; Bidra et al., 2012; Brown & Shaw, 2010; designs for obturator prostheses (Aramany, 1978). In the
Brown et al., 2000; Carrillo et al., 2005; Cordeiro & Aramany era of classification systems, the defects were charac-
Santamaria, 2000a, 2000b; Costa et al., 2015; Davison et al., 1998; terized simply based on anatomic landmarks of the defects and
Durrani et al., 2013; Futran & Mendez, 2006; Ohngren, 1975; Okay lacked appropriate algorithms for reconstruction (Aramany,
et al., 2001; Rodriguez et al., 2007; Shrime & Gilbert, 2009; Spiro 1978). However, the current literature has focused more on
et al., 1997; Triana et al., 2000; Umino et al., 1998; Wells & reconstruction options, for specific defects.
Luce, 1995; Yamamoto et al., 2004). The purpose of this review was to map all maxillary arch
Even with the advent of numerous classification systems, there defect classification systems available in the literature and
still remains a confusion regarding the use of terminologies such as describe a pragmatic classification series for edentulous maxillary
limited, partial, subtotal, and total. Bidra et al. suggested six criteria arches with defects by applying the Aramany classification
for the universal assessment of these existing classifications and criteria to enhance treatment outcomes and communication
concluded that no one system has succeeded in including all the among practitioners.
relevant criteria (Bidra et al., 2012).
Two grouped categories of defect classifications in the literature
are based on the extension of surgical resection and the remaining 2 | M A T E R I A L S AN D M E T H O D S
teeth, or from the prosthodontist's and/or head and neck surgeon's
perspective after completion of surgical reconstruction of the defect 2.1 | Protocol and registration
(Aramany, 1978; Brown et al., 2000; Cordeiro & Santamaria, 2000a;
Davison et al., 1998; Spiro et al., 1997; Triana et al., 2000; Umino This review was conducted according to the Preferred Reporting
et al., 1998; Wells & Luce, 1995). The earliest and simplest Items for Systematic Reviews and Meta‐Analyses (PRISMA) protocol.
classification of maxillary diseases was given by Ohngren in 1933 The review protocol was registered at the Prospectively Registered
(Ohngren, 1975). Since Ohngren did not believe in radical resection Systematic Reviews (PROSPERO) platform under (370285).
of maxillary tumors, his classification system was based on establish-
ing resectability criteria and did not consider the postsurgical defect
(Akinmoladun et al., 2013; Ohngren, 1975). 2.2 | Focused question and search strategy
Aramany in 1987 was the first to describe the surgical defect
of partially dentate maxilla (Aramany, 1978). His classification The focused question was determined according to the 2009 PICO
was based on the frequency of occurrence of defects in a cohort strategy (Furlan et al., 2009). (1) Population: maxillary arch OR
of 123 patients (Aramany, 1978; Bidra et al., 2012; Brown & complete edentulous OR partial edentulous OR dentate; (2)
Shaw, 2010; Brown et al., 2000; Carrillo et al., 2005; Cordeiro & Intervention: surgical resection OR maxillectomy OR maxillary arch
Santamaria, 2000a; Davison et al., 1998; Futran & Mendez, 2006; resection; (3) Comparison: N/A. (4) Outcome: classification OR
Okay et al., 2001; Rodriguez et al., 2007; Shrime & Gilbert, 2009; category OR types. The focused questions of the present review
Spiro et al., 1997; Triana et al., 2000; Umino et al., 1998; Wells & was “Among the available studies on maxillary arch defect
ALQARNI ET AL. | 47

classifications, what factors are the classification systems based on? 2.6 | Quality assessment
Is the available maxillectomy classification system applicable to
edentulous maxillary arches? Interobserver calibration was evaluated using Cohen's Kappa, and
the chosen cutoff point was 80%. GRADE criteria were used to
provide a framework for quality assessment of the selected
2.3 | Selection criteria studies.25 The quality levels ranged between high (H) and
moderate (M), Low (L), and very low (VL). Quality reflects the
Inclusion criteria confidence that the estimate of the effect was correct. GRADE
separates the process of quality assessment of evidence from
1‐ In vivo studies that classified maxillary arch defect, resection, or that of formulating recommendations (Balshem et al., 2011).
maxillectomy.
2‐ Patients with dentation, partial dentation, or edentulous maxil-
lary arch. 3 | RESULTS
3‐ Any of the following outcomes were evaluated; classification,
categorization, and/or types. Electronic searches using Cochrane, PubMed/MEDLINE, and
Google Scholar along with manual searches, were performed. A
Exclusion criteria total of 570 articles were screened and 17 published research
were selected for data extraction. The characteristics of each
1‐ In vivo studies which classified mandibular arch defect, resection classification are summarized in Table 1 (Bidra et al., 2012).
or mandibulectomy.
2‐ Animal studies.
4 | D IS CU SS IO N

2.4 | Search methods Defect extension in the maxillary arch has been described in
multiple planes as involvement of different regions of the maxilla
Two independent authors (H. Q. and WMA) systematically (Aramany, 1978; Bidra et al., 2012; Brown & Shaw, 2010; Okay
searched the indexed literature in January 2022, and updated it et al., 2001). It is important to recognize the location of defect, as
in August 2022. An electronic search of the literature related to treatment modality varies significantly between the anterior and
this subject between 1978 and 2022 was performed, with posterior regions of the maxilla (Aramany, 1978; Bidra et al., 2012;
specified classifications of dentoalveolar defects in Cochrane Okay et al., 2001). Anterior region defects result in lip
Library, PubMed/MEDLINE and Google Scholar using the search incompetency, drooling, speech difficulty, collapse and deformity
terms “maxillectomy classification” AND “surgical resection”, of nose, trismus, and formation of scar tissues, all of which have to
“maxillectomy classification” AND “complete dentulous.” Combi- be factored in the prosthesis design (Bidra et al., 2012). Arch
nations of medical subject heading terms (MeSH) and non‐MeSH discrepancy from bilateral defects involving maxillae would require
terms, along with Boolean operators, were utilized to perform the reverse articulation of denture teeth arrangement (Bidra
search. Relevant literature was also searched through Open Grey et al., 2012). Treatment planning for posterior defect rehabilitation
until January 2022. A manual search of the available literature may be affected by the resection of the soft palate, which could
was also performed without any language or publication restric- result in insufficient/inadequate velopharyngeal closure. This
tions. The following journals were manually checked: Journal of would require fabrication of a palatopharyngeal obturator to
Prosthetic Dentistry, Journal of Prosthodontics, and Advanced achieve adequate soft palate function and velopharyngeal compe-
Journal of Prosthodontics. tency (Bidra et al., 2012).
The obturator extends to the inferior conchae or even further
distally to the posterior pharyngeal wall in cases of bilateral
2.5 | Study selection and data extraction posterior defects (Class V) and soft palate resections. This can
lead to loss of retention and stability due to increase in size and
EndNote citation manager was used to import all the articles weight of the obturator; and also cause leakage of fluids and
collected from the three databases. Subsequently, duplications were air if there are no existing teeth or endosseous implants (Bidra
removed. Titles and abstracts were filtered (by H. Q. and WMA) et al., 2012). The placement of endosseous dental implants in the
according to the inclusion and exclusion criteria. Any disagreements residual alveolar ridge of the maxilla can improve retention and
between reviewers were resolved through discussion. Full‐text stability of the obturator (Aramany, 1978; Bidra et al., 2012; Okay
screenings were performed, and data related to classification of et al., 2001). Only three of the existing 17 classifications were
maxillary arch defects were obtained. based on prosthetic considerations. These are the classifications
48 | ALQARNI ET AL.

TABLE 1 Details of all the classifications included in this review

Author Year Isolated Communicated Dentate Total Partial

defect defect Maxillectomy Maxillectomy

Armany2 1978

Wells et al3 1995

Spiro at al4 1997

Davidson et al5 1998

Umino et al6 1998

Brown et al7 2000

Cordeiro et al8 2000

Triana et al9 2000

Okay et al10 2001

Yamamoto et al11 2004

Carillo et al12 2005

Futran et al13 2006

Rodriguez et al14 2007

Brown et al15 2010

Bidra et al16 2012

Durrani et al22 2013

Costa et all23 2015

by Aramany (1978); Okay et al. (2001); and Rodriguez maxillectomy with involvement of at least two walls including the
et al. (2007). palate, subdivided further into anterior, inferior medial, and lateral
Aramany classification remained the standard for almost two types; Class III, total maxillectomy which was complete resection of
decades. However, his classification was devised purely from a maxilla with or without orbital involvement (Spiro et al., 1997). Brown
prosthodontic perspective, and mainly discussed the palate and alveolar et al. proposed the first classification since Aramany's, which focused
ridge. It did not address the involvement of contiguous structures such as on both surgical and prosthodontic approaches toward a classifica-
nose, cheek, and outer skin, orbital contents, zygoma, and pterygoid tion of palatal defects (Bidra et al., 2012; Brown & Shaw, 2010;
plates; thus, was not an effective tool for describing surgical defects Shrime & Gilbert, 2009). After analyzing 487 patients, they divided
(Bidra et al., 2012; Shrime & Gilbert, 2009). the maxillary and midface defects based on the vertical (Classes 1–4)
Spiro et al. (1997) described the difficulty with maxillary defect and horizontal (classes a–c) components of tissue defects (Bidra
classification and proposed a classification system based on et al., 2012; Brown & Shaw, 2010; Shrime & Gilbert, 2009).
retrospective evaluation of 442 maxillectomies and orofacial resec- The surgical components (vertical) were as follows: Class 1,
tions performed over a period of 9 years. They proposed three types maxillectomy not causing oronasal fistula; Class 2, maxillectomy not
of procedures in this classification scheme: Class I, limited max- involving the orbit; Class 3, maxillectomy involving the orbital
illectomy with involvement of one wall; Class II, subtotal adnexae with orbital retention; Class 4, maxillectomy with orbital
ALQARNI ET AL. | 49

enucleation or exenteration; Class 5, orbitomaxillary defect; and Class maxillectomy, while the subdivision was based on the extent of loss
6, nasomaxillary defect. of palate; and (2) total maxillectomy, subdivided based on orbital
The dental components (horizontal) were: a, palatal defect only; b, exenteration, and amount of loss of malar bone and zygomatic arch
less than or equal to half of the bilateral maxilla; c: less than or equal to (Triana et al., 2000). This system was not comprehensive and failed to
half of the unilateral maxilla; and d, greater than half of the maxillectomy. facilitate easy communication (Akinmoladun et al., 2013; Bidra
Brown's intention was to provide a framework for prosthodontic et al., 2012; Cordeiro & Santamaria, 2000b; Ohngren, 1975; Shrime
rehabilitation, predict future prognosis, and guide the surgeons in & Gilbert, 2009; Triana et al., 2000).
reconstructing the defect. In 2010, this system was revised to In the following year, Okay et al. (2001) proposed to organize
account for the orbitomaxillary region as a Class V defect and and define the nature of prosthetic decision‐making and patient
nasomaxillary defects as Class VI, as well as the reconstructive satisfaction. Moreover, they were the first to directly consider the
approach, according to the given defect (Bidra et al., 2012; Brown & status of zygomatic arch and orbital floor (Okay et al., 2001). This
Shaw, 2010; Shrime & Gilbert, 2009). classification system was based on a retrospective review of 47
However, this system is comprehensive and too complicated to consecutive maxillectomy defects, and divided them into three major
use. The classification given by Brown et al. failed to describe the classes and two subclasses (Okay et al., 2001).
anterior‐posterior extent and skull base defect (Bidra et al., 2012; Class I a: Defects that involve any portion of the hard palate, but
Shrime & Gilbert, 2009). In addition, it did not mention the amount of not the tooth‐bearing alveolus.
skin loss and status of the palate and dentition (Bidra et al., 2012; Class I b: Defects that involve any portion of the maxillary
Shrime & Gilbert, 2009). alveolus and dentition posterior to the canines or involve the pre‐
ln the same year, Cordeiro and Santamarial expanded the Spiro maxilla with preservation of both canines.
classification, and proposed a classification system and an algorithm Class II: Defects that involve less than half of the hard palate of
for reconstruction of these defects by measuring the surface area and tooth‐bearing area and include only one canine.
using a wide variety of flaps (Cordeiro & Santamaria, 2000b). Their Class III: Defects involving resection of both canines or more
classification was as follows: than half of the hard palate; Class III f includes defects that involve
Type 1, limited maxillectomy, resection of one or two walls of the the inferior orbital rim; and Class III z, includes defects that involve
maxilla with preservation of the palate. the body of the zygomatic bone.
Type 2, sub‐total maxillectomy, resection of the maxillary arch, For reconstructive outcomes, Okay et al. were the only ones to
palate, anterior and lateral walls, and five out of six walls of maxilla describe the outcomes after rehabilitation for each defect (Okay
with preservation of the orbital floor; Type 3, total maxillectomy, et al., 2001). However, this classification was also very complicated and
resection of all six walls of maxilla with preservation of orbital failed to address defects involving contiguous contents such as orbital
contents. This type was further divided into two parts: Type 3a: total contents, soft palate, facial skin, and base of skull (Bidra et al., 2012;
maxillectomy with preserved orbital contents, type 3b: total Ohngren, 1975; Okay et al., 2001; Shrime & Gilbert, 2009). The Okay
maxillectomy with orbital exenteration; Type 4: orbito‐ classification system mainly considered dental and alveolar restoration for
maxillectomy, orbital exenteration with resection of five walls of obturator stability and retention (Bidra et al., 2012; Ohngren, 1975; Okay
maxilla, preserving the palate. et al., 2001; Shrime & Gilbert, 2009).
Reconstruction Algorithm: Umino et al. (1998) measured the speech intelligibility of 54
Type 1 Defect: Reconstruction with free non‐vascularized bone patients with or without a prosthesis after maxillectomy. They
may be required to replace bone in the critical area. Further concluded that oronasal communication played a major role in speech
obliteration can be performed using radial forearm fasciocutaneous intelligibility without a prosthesis; and developed a classification
flap (RFFF). system to help predict the grade of post‐maxillectomy speech
Type 2 Defect. RFFF can be used to reconstruct the missing disorder following surgery (Umino et al., 1998). They designated
palate. An osseo‐facio‐cutaneous RFFF can be used to reconstruct their classification based on location of the defects, either in the hard
anterior maxilla, which will also provide good lip support. Type 3a palate (Class I) or soft palate (Class II), and sub‐classified these based
Defect: Free nonvascularized bone can be used to reconstruct the on connections with the antral and nasal cavities (Umino et al., 1998).
orbital floor, and remaining defect can be closed using rectus Literature has classified defects based on their location, which
abdominus or temporalis flap. can be isolated, with or without oroantral communication, unilateral
Type 3b Defect: Reconstruction can be performed using rectus or bilateral (Bidra et al., 2012; Brown & Shaw, 2010; Brown
abdominus flap with skin paddles to reconstruct the palate, nasal wall, et al., 2000; Rodriguez et al., 2007). In partially dentate situations,
or facial skin. due to availability of surface area and abutments that can provide
Type 4 Defect: Reconstruction can be performed using a rectus adequate retention and stability for the obturator, management of
abdominus flap with or without skin paddles. isolated or unilateral defects (Class II–III, VI) can be surgically or
In 2000, Triana et al. (2000) classified and divided the defects prosthetically achieved based on the size and location of the defect
into three classes based on vertical extension and the affected area (Bidra et al., 2012). However, in edentulous maxillary arch bilateral
of the palate. They designated their classification as (1) inferior partial defects (Class I, II, IV, V, and VII) involving both maxillae, placement of
50 | ALQARNI ET AL.

endosseous implants to provide support and stability of the maxilla. Durrani et al. classification can be subdivided into unilateral
prosthesis is indicated (Bidra et al., 2012; Okay et al., 2001). Other and bilateral defects (Durrani et al., 2013).
authors have reported considerations for prosthodontic rehabilitation On the other hand, Costa et al. (2015) classified maxillary arch
of unilateral and bilateral defects in partially dentate patients defects into: 1) Type 1 defects or limited maxillectomy, which
(Aramany, 1978; Bidra et al., 2012; Okay et al., 2001). includes resection of one or three walls of maxilla with or without
Durrani et al. (2013) proposed a maxillectomy classification palate; 2) Type II defects or subtotal or infrastructural maxillectomy,
based on the clinician's guidance of the reconstructive and rehabili- which includes resection of five walls of the maxilla; 3) Type III
tation options. Type 1: alveolectomy, the surgical defect that involves defects or total maxillectomy, which includes resection of six walls of
only alveolar bone with, no oronasal or oroantral fistulas, which could the maxilla; and 4) Type IV defects or orbital or suprastructural
be covered by the denture; Type 2: subtotal maxillectomy, the maxillectomy, which includes resection of five walls of the maxilla
surgical defect that involves oronasal or oroantral fistula without along with the orbital contents, with preservation of palate and
disturbing the orbital walls, where obturator or local flap can be used; maxillary arch (Costa et al., 2015).
Type 3, total maxillectomy, the surgical defect involves complete
removal of maxilla and orbital floor without involving the orbital
contents. An obturator that extends to the orbit or regional flap can 5 | PROPOSED UNIVERSA L
be used. Type 4: radical maxillectomy, when the resection involves CLAS SIFIC ATION
removal of the orbital contents alone with the maxilla and orbital
floor. A prosthetic appliance and eyeball alone with skin graft can be To discuss edentulous arch defects in maxillectomy patients in a
used; and Type 5: composite maxillectomy, when facial skin, soft simple and effective manner, a universal classification is shown in
palate, and/or other parts of the oral cavity are resected with the Table 2. The horizontal components of the proposed classification is

TABLE 2 Proposed treatment options for individual classification defect

D
Superstructural or C B A
Orbitomaxillectomy Total MaxillectomyTotal Infrastructural Limited Resection

Myocutaneous rectus Myocutaneous rectus OmIC‐osteomuscular Iliac crest X 0

abdominis (McRA) abdominis (McRA) FRF‐faciocutaneous radial
Myocutaneous latissimus Myocutaneous latissimus forearm
dorsi (McLD) dorsi (McLD)

Myocutaneous latissimus OmIC‐osteomuscular Iliac crest FRF‐faciocutaneous radial Obturator Prosthesis 1

dorsi (McLD) OmFe‐osteomnuscular fibula forearm Midline
Myocutaneous rectus Midline
abdominis (McRA)
OmcF‐osteomyocutaneous fibula

X X N/A Obturator Prosthesis 2

Unilateral

X X X Obturator Prosthesis 3
Central

X N/A OFRF‐osteofasciocutaneous N/A 4

radial forearm Bilateral
OmIC‐osteomuscular Ilic crest
OmcF‐osteomyocutaneous fibula

X X N/A FRF‐faciocutaneous radial forearm 5

OFRF‐osteofasciocutaneous radial Posterior
forearm

X X N/A OmIC‐osteomuscular Iliac crest 6

OFRF‐osteofasciocutaneous radial Anterior
forearm

X X N/A FRF‐faciocutaneous radial forearm 7

OFRF‐osteofasciocutaneous radial Middle
forearm

Description: Classification for edentulous dental arches with maxillectomy defects: Zero mean does not belong to any of these criteria or classification,
Class I, midline resection, Class II, unilateral resection, Class III, central resection of the hard palate, Class IV, bilateral anterior‐posterior resection extended
beyond the incisive papillae, Class V, posterior resection, Class VI, anterior resection, and Class VII, middle resection of the remaining residual alveolar
ridge bilaterally.
ALQARNI ET AL. | 51

divided into seven groups based on the relationship between defect Class II: Unilateral defect with intact anterior, and one side of the
area and remaining edentulous area (Figure 1). The sequence of the residual alveolar ridge on the contralateral side (Figure 2a,b).
Aramany classification for partially edentulous patients was followed Class III: The defect occurs in the middle portion of the hard
(Aramany, 1978). palate with intact remaining residual alveolar ridge (Figure 3a,b).
Class I: The defect is located along the midline of the maxillary Class IV: The defect crosses the midline and involves both sides
arch, which involves the incisive papilla (Figure 1a,b). of the maxilla (Figure 4a,b).

F I G U R E 1 Classification for edentulous dental arches with maxillectomy defects: (a) Schematic diagram designed according to the proposed
classification. (b) Occlusal view of the printed cast showing the defect. (a and b). Class I, midline resection.

FIGURE 2 (a) and (b) Class II, unilateral resection.

FIGURE 3 (a) and (b) Class III, central resection of the hard palate.
52 | ALQARNI ET AL.

Class V: Bilateral defect posterior to the remaining residual Class VII: The defect cross the middle region of the alveolar ridge
alveolar ridge (Figure 5a,b). and involves both sides of the maxilla. A part of the residual alveolar
Class VI: Defects occur in the anterior region of the maxillary ridge remains, which lies posterior and anterior to the defect
alveolar ridge, preserving the posterior portion bilaterally. This is a (Figure 7a,b).
common presentation of congenital defects and defects caused by The vertical component of the proposed classification was
trauma (Figure 6a,b). divided into four categories by alphabetical letters: A, B, C, and D.

FIGURE 4 (a) and (b) Class IV, bilateral anterior‐posterior resection extended beyond the incisive papillae.

FIGURE 5 (a) and (b) Class V, posterior resection.

FIGURE 6 (a) and (b) Class VI, anterior resection.

ALQARNI ET AL. | 53

FIGURE 7 (a) and (b) Class VII, middle resection of the remaining residual alveolar ridge bilaterally.

A‐ Category: Limited to maxilla, including resection of one or three classification system with clear characteristics for edentulous max-
walls of the maxilla with or without comprising the palate. It can illectomy dental arch defects has been proposed. This classification
be combined with horizontal components of Classes 1, 2, 3, 4, 5, was modeled after the Aramany classification, which makes it easier
6, and 7. to memorize and apply.
B‐ Category: Infrastructural including resection of the lower five
maxillary walls, including maxillary arch, palate, anterior, posterior, A UT H O R C O N T R I B U TI O NS
medial, and lateral walls without the orbital floor. It can be combined Hatem Alqarni contributed to the design of the study, search, and
with horizontal components of Classes 1, 2, 4, 5, 6, and 7. selection, and drafted the manuscript. Hatem Alqarni, Mohammed
C‐ Total maxillectomy includes resection of all six walls of the Alfaifi, Mathew Kattadiyil contributed to the study, and Hatem
maxilla, with or without the orbital content. This can be Alqarni, Rana Almutairi, and Walaa Magdy contributed to the analysis
combined with horizontal components 1 and 4. and interpretation and critically revised the manuscript. Hatem
D‐ Orbitomaxillectomy or suprastructural resection includes resection Alqarni, Mohammed Alfaifi, Walaa Magdy Rana Almutairi, and
of the upper five walls of maxilla with orbital contents, and without Mathew Kattadiyil contributed to the conceptualization and design
palate or maxillary arch. It cannot be combined with any horizontal of the study, search and selection, analysis and interpretation, and
component. It can be managed using selected free flaps, such as critically revised the manuscript. All the authors gave final approval
myocutaneous rectus abdominis or myocutaneous latissimus dorsi. and agreed to be accountable for all aspects of the work, ensuring
integrity and accuracy.
This proposed classification provides an accurate description of
maxillectomy defect/maxillary resection for edentulous patients in DATA AVAILABILITY STATEMENT
horizontal and vertical perspectives, and allows a realistic comparison of NA Comments to Payment Admin.
pretreatment and posttreatment outcomes of surgical reconstruction
and/or prosthodontic rehabilitation of maxillary defects. The authors ORC I D
believe that the development of a systematic classification of max- Hatem Alqarni http://orcid.org/0000-0001-9394-3312
illectomy defects for edentulous patients has value for students, teachers, Walla M. Ahmed http://orcid.org/0000-0003-1810-8733
and practitioners. The presence of several classification systems in the
literature demonstrates a lack of consensus and reveals the challenges RE F ER EN CES
involved in classifying maxillectomy defects in partially edentulous Akinmoladun, V. I., Dosumu, O. O., Olusanya, A. A., & Ikusika, O. F. (2013).
patients and lack of information and standardized classification for Maxillectomy defects: A suggested classification scheme. African
Journal of Medicine and Medical Sciences, 42(2), 171–175.
edentulous patients. This classification can also help standardize
Aramany, M. A. (1978). Basic principles of obturator design for partially
categorization for future research on maxillectomy defects. edentulous patients. Part I: classification. The Journal of Prosthetic
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