The maxilla consists of several sections that form the skeletal base of most of the upper face, roof of the mouth, sides of the nasal cavity, and the floor of the bony portion of skull that holds and protects the eyeball (orbit). The portion known as the alveolar process supports the teeth. Loss of half or less of the maxilla may cause disruptions in function and deformity to any of the areas that it supports.

Loss or destruction of the maxilla may result from trauma such as gunshot wounds, infection, and tumors, including cancer.

Loss of more than half of the maxilla may result in functional, cosmetic and psychological problems. Functionally, this loss may affect ability to chew and swallow food, and the ability to breathe normally. Cosmetic losses vary according to the amount and location of tissue loss. Psychological effects relate to patient's ability to cope with the functional and cosmetic losses. The level of severity of all of these effects relates to the extent to which losses can be restored with a dental prosthesis.

Evaluation by physical examination, plain x-rays, and computed tomography (CT) scan are used to demonstrate abnormalities.

Following treatment for the conditions causing the defect, additional therapy is directed at reconstruction and rehabilitation. This may involve reconstructive surgery to restore bone and soft tissues, and to provide anchorage for prostheses with dental or maxillofacial implants. Treatment involves construction of a dental or maxillofacial prosthesis to restore function and esthetics.

Residual effects depend on the extent of loss. Loss of maxillary structures may or may not be replaceable by prosthesis depending on the extent of injury or disease. Body image disturbances, which may require counseling, are possible after facial changes or surgery. Nutritional problems may occur due to the inability to chew (masticate), especially in cases that cannot be corrected by prosthesis.

• None.

• For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography.

• Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunction, and other impairments under the appropriate diagnostic code and combine under 38 CFR 4.25 for each separately rated condition.