Mandibulectomy is surgery to remove all or part of the jaw (mandible). Often the reason for this surgery is the presence of a tumor.
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Preparation for the operation
Before the surgery, it is necessary to consult a maxillofacial surgeon, plastic surgeon and dentist. Pre-operative blood and imaging tests are also done - MRI or CT scan. This assesses the extent of the tumour and the reconstruction that will need to be done after the mass is removed.
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During the operation
During the surgery, the maxillofacial surgeon removes the tumor and the soft tissues around it. The maxillofacial surgeon performs the reconstruction - he or she will remove bone, tissue and skin from the donor site. This takes 3 to 4 hours. Once he has completed his part of the surgery, the reconstruction can be performed.
The maxillofacial surgeon will transfer tissue from the donor site to reconstruct the jaw. The bone from the donor site will be shaped to match as closely as possible the part of your jaw that was removed. Once completed, the plastic surgeon will attach blood vessels from the donor site to blood vessels in the head and neck area. This is done under a microscope. The new jawbone is fixed in place with plates and screws and covered with soft tissue. The plastic surgeon will then place stitches in the face and neck to connect them to the soft tissue. The reconstructive part of the surgery usually takes 6 to 8 hours.
Mandibulectomy can cause swelling and difficulty breathing. A tracheostomy should be placed to make breathing easier. A probe will also be placed to assist with feeding during the first week after surgery until the jaw begins to heal. A special dressing may be placed on your donor site wound to enhance healing. It will be removed 5 to 7 days after surgery. If you have a cast, splint or sling, a dressing will be placed underneath.
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After the operation
After surgery, you will be under active medical supervision. You will have compresses on your legs to help blood circulation and prevent blood clots. During the first week after surgery, blood flow to your jaw and nearby tissues will be monitored. It is very important to avoid pressure on the reconstructed jaw. You will not be able to use a pillow while in the hospital.
The foot is the most common donor site for jaw reconstructions. If the jaw is being reconstructed using tissue from another donor site, the medical team will explain how to care for it.
For the first few days you will not be able to get out of bed. The following days you will start to stir, which will continue depending on the condition. During your stay in hospital, you will be explained how to care for your leg and skin graft if you have one. You will be explained how to care for your oral hygiene after the mandibulectomy.
Prevention of Trismus
Trismus is when you have trouble opening your mouth. It can develop after surgery or radiation therapy. It is caused by changes in the muscles around the jaw. It is necessary to start doing jaw exercises to prevent trismus.
Feeding for the first few weeks is with purees. Gradually as you recover, the type of foods you take will change.
