Imagine if someone develops oral cancer, or a severe infection in the lower jaw bone... sometimes the diseased part has to be completely removed surgically. So, in this article today, we are going to talk about a very important surgery that is performed in such a situation. Although this is a bit complicated topic, let's talk about it as simply as possible.
What is a mandibulectomy?
Simply put, a mandibulectomy is the surgical removal of part or all of your lower jawbone/mandible. Doctors usually perform this surgery to remove a cancerous tumor or other diseased part of the jaw. This is also called a mandibular resection .
What are the main types of this surgery?
This surgery can be divided into two main types. Let's see what they are.
| Type of surgery | Simply description |
|---|---|
| Partial Mandibulectomy (Marginal Mandibulectomy) | This involves removing only a small portion of your lower jaw. This usually eliminates the need for reconstructive surgery. |
| Segmental Mandibulectomy | In this procedure, a large portion of the lower jaw is removed. Therefore, the jaw must be reconstructed. To do this, surgeons take bone, blood vessels, and tissue from another part of your body (e.g., leg, shoulder) to reconstruct the jaw. This procedure is also called a free-flap reconstruction . |
Where do you get the bone to rebuild your jaw?
In a segmental mandibulectomy, we say that the bone fragments needed to rebuild the jaw are taken from other parts of the body. The most common methods used for this are:
- Lower leg
- Shoulder blade
- Hip
In some cases, metal plates or even bone from a donor can be used for this purpose.
Who needs this surgery?
There are several situations in which your doctor may recommend this type of surgery.
- If you have oral cancer .
- When you have cancer in the middle part of the throat (oropharyngeal cancer) .
- When there is a severe infection of the jaw bone (osteomyelitis) .
- When certain medications (bisphosphonate therapy) cause severe bone loss in the jaw (osteonecrosis of the jaw) .
- When there is a very serious injury to the lower jaw.
The most important thing is that your medical team will decide what treatment is best for you in this situation. Therefore, it is very important to talk openly with them and resolve your questions and concerns.
What happens before the surgery?
Before performing this type of surgery, your medical team will perform several tests, including a CT scan, to better assess the size and condition of the tumor in your jaw.
If you need jaw reconstruction surgery, additional tests may be performed to check the health of the blood vessels at the donor site.
Also, your doctor will advise you to avoid the following things before surgery, as these can increase bleeding during surgery and delay wound healing afterward.
- Alcohol
- Painkillers such as aspirin and ibuprofen
- Smoking
- Some herbal supplements
What happens during the surgery?
A mandibulectomy is a long surgery that lasts several hours. It is performed while you are asleep under general anesthesia .
In Marginal Mandibulectomy...
1. The surgeon will make an incision on the inside of your cheek.
2. The cancerous part of the lower jaw and the tissue around it are removed.
3. The incisions are sewn back closed.
In Segmental Mandibulectomy...
This is a more complex process.
1. First, the jaw cancer and the tissue around it are removed.
2. The removed parts are sent for a biopsy to check if there are still cancer cells.
3. It is also checked to see if the cancer has spread to the lymph nodes.
4. Then, a piece of bone, tissue, and skin is taken from a predetermined location (such as the leg, shoulder, etc.).
5. The extracted bone is shaped to fit the removed part of the jaw.
6. The blood vessels (arteries and veins) from the harvested area are connected to the blood vessels in the head and neck. This is done very carefully.
7. Finally, the new jaw is fixed with plates and screws, and the incisions are sutured closed.
After surgery, you may also need some of these things:
- Arch bars and rubber bands inside the mouth to keep the teeth and jaw in alignment.
- A tracheostomy tube to help you breathe.
- A feeding tube is a tube passed from the nose to the stomach to provide proper nutrition.
What happens after the surgery?
Depending on the type of surgery you had, you may need to stay in the hospital for two days to two weeks. After you go home, you should follow your doctor's instructions about keeping your incisions clean and eating . Initially, you may need to eat on a liquid diet or through a feeding tube. Also talk to your doctor about how to manage your pain.
During the healing process, you may need speech therapy and physical therapy. If you had cancer, radiation therapy or chemotherapy may also be recommended to kill any remaining cancer cells.
What are the symptoms that require immediate medical attention?
It is very important to seek medical advice immediately if you experience any warning signs after going home from surgery. Be on the lookout for the following symptoms:
| Feature to pay attention to |
|---|
| Fever greater than 100.5 Fahrenheit (38.05 Celsius) |
| Severe headache |
| Severe pain that does not subside despite taking painkillers |
| Difficulty breathing (dyspnea) |
| Severe swelling (angioedema) at the surgical site or elsewhere |
| Nausea or vomiting |
| A skin rash-like condition |
If you see anything like this, inform your doctor immediately. In case of an emergency, go to the Emergency Department (ETU) of the nearest hospital.
Take-Home Message
- Mandibulectomy is a major surgery used for serious conditions such as oral cancer and severe infections.
- In this, a small or large portion of the jaw is removed, and sometimes the jaw is rebuilt using bone taken from elsewhere in the body.
- The healing process takes time and requires the support of a medical team, including doctors and speech therapists.
- It is very important to follow all the instructions your doctor gives you before and after surgery.
- If you notice any warning signs after surgery, do not delay and seek medical advice immediately.
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