Current classifications of midface resections: scoping review and proposal of a new classification

Midface resection is a surgical procedure with varying degrees of complexity, ranging from partial upper jaw removal to exposure of the dura mater after resection. Existing classifications for the resulting midfacial defects are inconsistent and have issues regarding terminology, therefore a consensus is needed. The aim of this review was to analyse the previously published classifications, identify defining parameters, determine their strengths and weaknesses, and propose a universal classification for midfacial defects with the goal of being sufficiently detailed yet easily applied in clinical practice. A scoping review was conducted according to the PRISMA guidelines using the PubMed, Embase, and Wiley Online Library electronic resources. Analysis of the various midfacial resection classifications identified in the search revealed common parameters including anatomical landmarks, the walls removed, and the presence of oroantral communication, as well as an accompanying algorithm and options for reconstruction. The articles with the most detailed descriptions were noted. A new classification is proposed that includes elements of the three most detailed existing classifications, incorporating the vertical and horizontal extents of the defect, but with more specific details concerning severity and aimed at greater practical clinical utility.