Jawbone Surgery (Mandibular Joint Surgery): What You Need to Know

When your doctor tells you that you need to have part of your lower jaw surgically removed, you may feel a great sense of fear and shock. When you hear about this surgery called a 'mandibulectomy', you may have many questions in your mind. It's normal to have questions like, "Will my face change?", "Will I be able to talk and eat again?" But don't worry. In this article, we'll talk about this surgery, why it's done, how it happens, and what to expect after the surgery in a simple, understandable way.

Simply put, what is a mandibulectomy?

Simply put, a mandibulectomy is the surgical removal of part or all of your lower jawbone (mandible). This is sometimes called a 'mandibular resection'.

Doctors usually decide to perform this type of surgery if there is a cancerous tumor in the jawbone, if there is a severe infection, or if the jawbone has been damaged by some medical condition. The main goal is to completely remove the diseased part and stop the disease from spreading further.

What are the main types of this surgery?

Mandibulectomy surgery can be divided into two main types. It depends on how much of the jawbone is removed. Let's take a look at what those two types are.

Where do you get the bones for reconstruction?

In a segmental mandibulectomy, surgeons take bone, tissue, skin, and blood vessels (arteries and veins) from another part of your body to rebuild your jawbone. This is called a ``free-flap reconstruction.'' Think of it like taking a piece of fabric and patching it up to fix a torn part of your clothing.

The places where bones and tissues are usually taken for this are:

• Lower leg: Most often, a part of the fibula bone is taken.
• Shoulder blade: In some cases, part of the shoulder blade may be removed.
• Hip: A portion of the hip bone can also be taken for this purpose.

Sometimes, metal plates or bone grafts from another donor may be used. Your medical team will explain this to you.

In what cases is this surgery necessary?

A doctor will resort to this type of surgery for several very specific reasons. Among them, the main reasons are these.

• Oral cancer: If a cancer that forms inside the mouth, on the tongue, gums, or cheek, has spread to the jawbone.
• Oropharyngeal cancer: If cancer that starts in the middle part of the throat spreads to the jawbone.
• Bone Infection (Osteomyelitis): If you have a severe bacterial infection that has spread to the jawbone and is not responding to treatment.
• Osteonecrosis of the jaw: If the jaw bone dies due to the use of certain medications (especially bisphosphonates) or radiation therapy.
• Severe accidents: If the jawbone has been shattered into pieces in a severe accident and is too damaged to be repaired in any other way.

What happens before the surgery?

There is a period of preparation before surgery, during which the medical team gains a full understanding of your condition.

• Tests: Tests such as a CT scan are done to accurately measure the size and spread of the tumor or damaged area in your jawbone. If you are having reconstructive surgery, special tests are also done to check the health of the blood vessels at the donor site.
• Meeting with the medical team: This surgery is performed by a multidisciplinary team of doctors. This team may include a head and neck surgeon, a reconstructive surgeon, and an oral surgeon. They will discuss the surgery with you in detail.
• Things to stop: You will be advised to avoid things that may increase bleeding or interfere with the healing process during surgery.
• Alcohol
• Painkillers such as aspirin and ibuprofen
• Smoking (cigarettes) - This is very detrimental to the healing process.
• Some Ayurvedic or herbal medicines

Important: Be sure to tell your doctor about any medications you are currently taking, even vitamins.

What happens during the surgery?

This is a complex surgery that will take several hours. But you have nothing to worry about. You will be under general anesthesia throughout the procedure, so you will be sound asleep.

In Marginal Mandibulectomy...

1. The surgeon will make an incision on the inside of your cheek.

2. The tumor or diseased part of the jawbone is removed, along with a small amount of healthy tissue around it.

3. The incisions are closed and sutured.

In Segmental Mandibulectomy...

This is a somewhat lengthy process. Two surgical teams may work simultaneously. While one team performs the hip surgery, the other team prepares the donor site.

1. First, the diseased jawbone is removed along with the surrounding tissue.

2. The removed parts are sent to the laboratory for testing to see if cancer cells are present or if they have spread.

3. It is also checked to see if the cancer has spread to the lymph nodes in the neck.

4. The other surgical team takes the necessary bone, skin, and blood vessel sections from the bone graft site (e.g., the leg).

5. The extracted bone is shaped to exactly match the part removed from the jaw.

6. To provide blood supply to the transplanted tissue, those blood vessels are delicately connected to the blood vessels in your neck.

7. The new jaw part is attached to the jaw using special metal plates and screws, and the incisions are closed and sutured.

Additional things to do with the surgery

After surgery, you may need further treatment to keep your teeth and jaw in the correct position and to make breathing easier.

• Arch bars and rubber bands: These are placed inside the mouth to keep the teeth and jaw in proper alignment.
• Tracheostomy: A tube is placed in the front of the neck into the windpipe (trachea) to make breathing easier as the throat swells in the first few days after surgery. This is temporary.
• Feeding tube: Because it is difficult to eat by mouth, a tube is inserted through the nose into the stomach to provide the necessary nutrition and provide liquid food.

What happens after the surgery?

The recovery period requires a little patience.

• Hospital stay: Depending on the type of surgery you have, you may need to stay in the hospital for anywhere from two days to two weeks. Segmental surgery usually requires a longer stay.
• When you go home: After you go home, it is very important to follow the instructions given by your doctor exactly. You will be instructed on how to keep your incisions clean and how to eat. You may still have a feeding tube when you go home, or you may be told to only eat liquid foods. Take any pain medications you are given on time.
• Other treatments: During your recovery, you may need help from a speech therapist and physical therapist to help you learn to swallow and speak again. If you had surgery for cancer, your doctor may also recommend radiation therapy or chemotherapy to kill any remaining cancer cells.

How long does it take to fully recover?

It's hard to give an exact time for this. It varies from person to person and depending on the nature of the surgery.

• Recovery after a partial mandibulectomy is relatively quick.
• Recovery after a segmental mandibulectomy and reconstruction can take months. It takes time to relearn how to swallow, eat, and speak.
• It may take several weeks to return to work. You may need to wait even longer to start strenuous activities like exercise. Your medical team will give you a schedule that works for you.

What are the symptoms that require an urgent visit to a doctor?

If you develop any of these symptoms while at home after surgery, seek medical advice immediately. If necessary, go to the hospital's Emergency Department (ETU).