When a doctor tells you that you need to have major surgery on a part of your face, it's normal to feel a lot of fear and shock. At such a time, there are many questions that come to mind. "What kind of surgery is this? What will happen to me? Will my appearance change?" It's natural to think things like this. So today we're talking about a surgery that is also a bit complicated, but sometimes essential to save lives. That is the maxillectomy.
Simply put, what is maxillectomy?
A maxillectomy is the surgical removal of all or part of your upper jawbone (maxilla). Think of it this way: the maxilla is the part of your jaw that sits above your upper lip, on either side of your nose, and where your upper teeth rest. After this surgery, you often need to undergo reconstructive surgery to restore the removed part.
Why is it necessary to have this kind of surgery?
In most cases, the main reason for this surgery is cancer. This surgery is especially recommended if cancer has developed or spread to these parts of your body.
- Cancer of the maxilla .
- Nasopharyngeal cancer.
- Cancer that occurs on the roof of your mouth is called oral cancer.
- Sinonasal tumors.
Additionally, this surgery may sometimes be necessary due to a very serious fungal infection (invasive fungal sinusitis) . This is caused by a severe infection and tissue destruction in the sinus cavities when certain types of fungi are inhaled.
Is only the upper jaw always removed?
No. If the cancer has spread to nearby tissue, some of that tissue may need to be removed. In this case, all or part of the following may be removed:
- Eye
- Hard palate
- The nerve that provides sensation to the skin under the eye
- Bones around the eye (Orbit/eye socket)
- Orbital floor
- Teeth remaining in the upper jaw that are being removed
- Tear duct
This decision is made by a team of specialists, who carefully study the size of the cancer, how it has spread, and many other factors, such as tests such as MRI and CT scans. Your doctor will explain all the details to you.
What are the types of maxillectomy surgeries?
The type of surgery depends on the size and location of the tumor. To make it easier for you to understand, let's look at these types in a table.
| Type of surgery | What is simply done |
|---|---|
| Medial Maxillectomy | Removal of the upper jaw and associated teeth near the nose. Often done for cancers inside the nose, sometimes performed using an endoscope inserted through the nostril. |
| Infrastructure Maxillectomy | Removal of the lower part of the upper jaw, teeth, and upper palate. This creates a hole in the upper palate. Tissue taken from another part of the body or a special prosthetic is needed to close it. |
| Suprastructure Maxillectomy | Removal of the upper part of the upper jaw. This may involve removing parts such as the eye, the bones around the eye, and the tear duct. Major reconstructive surgery is required. Although a prosthetic eye can restore appearance, it cannot restore vision. |
| Subtotal (Partial) Maxillectomy | Removing only part of the upper jaw using one of the methods mentioned above. |
| Total Maxillectomy | Removal of the entire upper jaw, upper palate, and bony support under the eye on one side of the face. Requires extensive reconstructive surgery and prosthetic devices. |
What additional things are needed with this surgery?
You may have to face some other things during or after this surgery.
- Feeding tube placement: This is necessary to provide nutrition because it is difficult to take food by mouth.
- Dacryocystorhinostomy: This surgery is performed to control the outflow of tears from the eyes (watering) if the tear duct is removed.
- Neck dissection: If there is a suspicion that the cancer has spread to the lymph nodes in the neck, they are removed.
- Tracheostomy to help you breathe: If swelling in your face after surgery is thought to be affecting your airway, a small hole may be made in the front of your neck and a tube may be inserted to temporarily help you breathe.
- Reconstructive surgery: These are essential to restore removed parts of the face.
What are the benefits and risks of surgery?
The main advantage is that it removes cancerous tissue and increases the chance of survival .
However, like any major surgery, there are risks and complications that can occur.
- Bleeding and bruising (Hematoma).
- Blood clots.
- Sagging lower eyelid.
- Problems with the functioning of the Eustachian tube, which connects the ear and throat.
- Infection.
- Numbness in the cheek due to nerve damage.
- Frequent watering of the eyes (Epiphora).
Your medical team will educate you about these risks.
Things to know about recovery time
Recovery depends on the type of surgery you had.
While in the hospital
During the initial recovery period, you can expect:
- You may need to stay in the hospital for up to two weeks , especially if you had major reconstructive surgery.
- You will be given medication for pain, to prevent blood clots, and to prevent infection.
- Supplemental oxygen will be given through the tracheostomy.
- Supplemental nutrition will be provided through a feeding tube.
After coming home from the hospital
- Avoid strenuous work until you are well.
- Eat only liquids and soft foods until the surgical wounds heal.
- Avoid hot foods and drinks , as some parts of your mouth may be numb.
Recovery can take months, especially to regain the ability to speak and swallow. Patience is key.
If you have these symptoms, call your doctor immediately.
If you experience the following symptoms during your recovery, contact your doctor immediately.
- If the swelling increases abnormally .
- If you feel difficulty breathing .
- Fever (this may be a sign of an infection).
- If there is pain that cannot be controlled even after taking painkillers.
Specialists to help you during your recovery
This is not a journey you should go on alone. There is a team of experts to help you.
- Dietitians: Provide advice on how to get the nutrition you need, even when it's hard to eat.
- Medical or radiation oncologists: Coordinate other cancer treatments, such as chemotherapy and radiation therapy.
- Prosthodontists: They help you regain the ability to eat with special artificial teeth and appliances.
- Speech therapists: Help you learn to speak, swallow, and eat again.
Take-Home Message
- Although a maxillectomy is a major surgery, it is often a life-saving treatment.
- Recovery is a process that takes time and patience. You may have to retrain yourself to speak and swallow.
- Your appearance may change, but it can be largely restored with reconstructive surgery and prosthetic devices.
- There is a large team of doctors, speech therapists, and dietitians to help you on this journey.
- Talk openly with your doctor about any questions or concerns you may have.
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