When a doctor talks to you or someone close to you about a major surgery like a maxillectomy, it's normal to feel a great deal of fear and shock. As soon as we hear a word like this, a number of questions arise in our minds. "What kind of thing is this?", "Why do I need to do this?", "What will my life be like after this?" You may also have questions in your mind. That's why, to reduce your fear and doubts about this, we thought we would talk about this surgery in a very simple and friendly way.
What exactly is maxillectomy?
Simply put, a maxillectomy is the surgical removal of all or part of your upper jaw bone (maxilla). The upper jaw contains the upper teeth. This is not just a simple removal. Often, this surgery is accompanied by reconstructive surgery to restore the removed part, that is, to improve the appearance. Therefore, this is a very complex and well-planned procedure performed by a team of skilled doctors.
Why is it necessary to have such a major surgery?
The main reason for this is cancer. Especially if cancer develops in your upper jaw or if cancer from elsewhere has spread to this area, this surgery is essential to completely remove the cancer cells.
There are several main situations in which doctors recommend this surgery:
- Cancer of the Maxilla: If cancer develops directly in the maxilla bone.
- Nasopharyngeal Cancer: If cancer that originates in the nose spreads to the upper jaw.
- Oral Cancer: Cancer that occurs in the roof of the mouth.
- Sinonasal Tumors: Cancers that develop in the sinus cavities inside the face and spread to the upper jaw.
In addition to these types of cancer, this surgery is sometimes performed in cases of very serious fungal infections (invasive fungal sinusitis) . This is a serious infection that occurs when certain types of fungi are inhaled, which spread and destroy the tissue inside the sinuses.
The most important thing is that this surgery is performed with the primary goal of completely removing the cancer and saving your life.
Does this surgery only remove the upper jaw?
This is a problem for many people. Depending on the size of the cancer and how far it has spread, it may be necessary to remove nearby tissue or organs in addition to the upper jaw. This may sound scary, but it is necessary to completely remove the cancer.
The surrounding areas that may need to be removed are:
- Eye: If the cancer has invaded the eye.
- Hard Palate: The top part of the mouth.
- Orbit: The bony cavity in which the eye is located.
- Orbital Floor: The bony floor that holds the eyeball in place .
- The nerve that provides sensation to the skin under the eye: This may cause tingling in the cheek area after surgery.
- Teeth related to the upper jaw that are being removed.
- Tear Duct: The tube that carries tears from the eye to the nose.
Whether or not these things are removed depends on the stage of your cancer. Your doctor will explain all of this to you.
What are the main types of this surgery?
The type of maxillectomy surgery performed varies depending on the size and location of the tumor. Let's take a look at the main types.
| Type of surgery | Simply explained |
|---|---|
| Medial Maxillectomy | This involves removing part of the upper jaw near the nose and the teeth associated with it. This is often done for small tumors inside the nose. This can be done through a small incision on the side of the nose or through a thin tube (endoscope) inserted through the nostril. This usually does not require major reconstructive surgery. |
| Infrastructure Maxillectomy | In this procedure, the lower part of the upper jaw, teeth, and palate are removed. This creates a hole in the roof of the mouth. To close this hole, a flap of tissue is taken from another part of the body and transplanted. Otherwise, a special prosthetic is used to close the hole. |
| Suprastructure Maxillectomy | This involves removing the upper part of the upper jaw. It may also involve removing the teeth, the orbital floor, the orbit, the eye, the tear duct, and the surrounding nerves. Major reconstructive surgery is required to repair the removed parts. If the eye is removed, a prosthetic eye can be inserted to restore the appearance, but it is important to remember that it will not restore vision . |
| Subtotal (Partial) Maxillectomy | In this, only part of the upper jaw is removed using one of the methods mentioned above. |
| Total Maxillectomy | This is the most extensive part of the surgery. The entire upper jaw on one side of the face is removed, along with the palate and orbital floor. This requires extensive reconstructive surgery and prosthetic devices. |
Are there any additional things to do with this surgery?
Yes, sometimes a maxillectomy alone may not be enough. Depending on your condition, you may need to have several other procedures done at the same time or after this surgery.
- Feeding Tube Placement: Since it is difficult to eat or drink normally by mouth for a while after surgery, a tube is placed through the nose or directly into the stomach to provide the necessary nutrition.
- Dacryocystorhinostomy: A surgery to remove the tear duct, creating a new path for tears to drain from the eye.
- Neck Dissection: If there is any suspicion that the cancer has spread to the lymph nodes in the neck, they are removed and examined.
- Tracheostomy: If doctors think that swelling in the face will cause difficulty breathing after surgery, they may insert a tube directly into the windpipe at the front of the neck to temporarily help you breathe.
- Reconstructive Surgery: These surgeries are performed to restore the appearance and function of the face as much as possible.
What are the benefits and risks of this surgery?
Like any major surgery, this one has its benefits and risks.
| Main advantage | Possible risks and complications |
|---|---|
Saving lives. The biggest and only advantage of this surgery is that it prevents the spread of the disease and provides a better chance of survival by removing the cancerous tissue from the body. |
|
How is the recovery time after surgery?
This is a long journey. You need to prepare for it both physically and mentally. The healing process can be divided into several parts.
Time in the hospital
Depending on the nature of the surgery, you may need to stay in the hospital for a week to two weeks or more . This time may be longer if you had major reconstructive surgery. During this time:
- Medication is given to control pain and prevent infection.
- Oxygen may be given to help with breathing (through a tracheostomy if one has been placed).
- Nutrition is provided by giving liquid food through a feeding tube.
Things to take care of after returning home
You still need to be very careful after you get home from the hospital.
- Avoid strenuous activities completely until your doctor tells you to.
- Eat only liquids and soft foods until the cuts heal.
- Avoid hot foods and drinks because some parts of the mouth may be sensitive to heat, which can burn the mouth.
How long does it take to fully recover?
This can take months. It will take time for your ability to speak and swallow to return to normal. The recovery time will depend on the type of surgery you had.
- Since medial maxillectomy is a minimally invasive surgery, recovery is relatively quick.
- Infrastructure, Suprastructure, and Total maxillectomy are very complex surgeries, so the hospital stay and recovery time at home can be very long.
When should you talk to the doctor?
If you develop any dangerous symptoms during your recovery, you should immediately inform your doctor or the hospital where you received treatment. Be especially aware of these symptoms.
* If there is unusual swelling .
* If you feel difficulty breathing .
* If you develop a fever (this may be a sign of an infection).
* If you experience severe pain that cannot be controlled by the painkillers provided.
In a situation like this, don't be late.
What impact will it have on my life after recovery?
Most people recover successfully from this surgery. The incisions heal well. However, removing the upper jaw and surrounding areas brings some changes to life. Things that were previously very simple, such as eating, talking, and swallowing, can be a challenge.
But don't worry. There are many people who can help you overcome these challenges.
- Speech Therapists: Help you relearn how to speak, swallow, and eat.
- Dietitians: Helping the body get the nutrition it needs, even when it's hard to eat.
- Prosthodontists: They can make special dentures for you and help you regain the ability to chew food.
- Oncologists: Coordinate additional cancer treatments, such as chemotherapy or radiation therapy, that may be needed after surgery.
Your ultimate recovery depends on the type of cancer and its severity. But with proper medical care and your own efforts, many people have been able to overcome these challenges and return to normal life.
Take-Home Message
- Maxillectomy is a very important, potentially life-saving surgery for head and neck cancers.
- The recovery period after this surgery may be long. Eating and speaking may be affected.
- There is a large medical team, including doctors, speech therapists, and nutritionists, to help you. Get their support.
- Report any dangerous symptoms (fever, severe pain, difficulty breathing) to your doctor immediately during your recovery.
- Although this journey is challenging, with the right support and a positive attitude, you can live a good life again.
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