A functional Schneiderian membrane-preserving maxillectomy: leveraging mucosal bone-forming potential and clinical effectiveness verification

OBJECTIVES: This study aims to propose an improved maxillary resection technique preserving Schneider's membrane and evaluate its clinical value in postoperative bone regeneration, complication control, and functional recovery. MATERIALS AND METHODS: This study included 17 patients who were randomly divided into a modified group (with Schneiderian membrane preserved, n = 8) and a traditional group (n = 9). We compared the two groups on bone regeneration in the maxillary sinus floor after surgery, complication rates (oronasal fistula and empty nose syndrome), and functional recovery. RESULTS: After surgery, clear bone regeneration was seen in all patients in the modified group (bone height 1.89 ± 0.16 mm, volume 614.30 ± 58.73 mm³). The traditional group showed no effective bone regeneration (p < 0.001). None of the patients in the modified group developed oronasal fistula or empty nose syndrome. The modified group also had significantly better outcomes than the traditional group in postoperative bite force (180.63 ± 16.23 N vs. 92.22 ± 29.75 N, p = 1.8 × 10⁻⁶), swallowing function grade(2.75 ± 0.46 vs. 2.11 ± 0.33,p = 0.003) and total UW-QOL score (77.75 ± 5.56 vs. 66.11 ± 6.48,p = 0.001). CONCLUSIONS: This method reduces complication rates and improves functional recovery and quality of life. CLINICAL RELEVANCE: The modified technique leverages the bone-forming potential of the mucosa, enabling immediate closure of the oral-nasal communication and promoting gradual bone regeneration. This approach represents a conceptual shift from simple lesion removal toward functional and structural reconstruction, offering new possibilities for function preservation and structural restoration after maxillary tumor resection. Furthermore, given the small sample size of this study, subsequent validation in larger prospective studies could further facilitate its broader clinical application. TRIAL REGISTRATION: Trial was retrospectively registered at clinicaltrials.gov [NCT07320417/2025-12-22].