A mandibulectomy is a surgical procedure in which a portion of the jaw bone (mandible) is removed. It is performed to remove the infected or cancerous part from the lower jaw. It usually takes 3-4 hours to perform this surgery. Mandibulectomy can be performed in the following scenario:
- Infectious etiologies like osteomyelitis
- Osteoradionecrosis,
- Benign conditions like ameloblastoma
- Malignant neoplastic processes like invasive squamous cell carcinoma
Where Is It Located?
The mandible is the biggest bone found in the human skull. It performs functions like holding the lower teeth in place, assisting in mastication, and forming the lower jawline.
The Surgery
Marginal Mandibulectomy and Segmental Mandibulectomy are two different types of mandibulectomies.
Marginal Mandibulectomy: Only a piece of the mandible is removed in this procedure, and the bone remains continuous. It is usually performed when a tumor grows up against the jawbone, but does not invade it.
Segmental Mandibulectomy: As the name suggests, a cut is made through the complete thickness of the jaw, and an entire part of the bone is removed in this procedure. This creates a gap in the mandible and requires further reconstruction to keep functionality intact. Nerves might get affected in this area, which can be restored partially if a nerve graft is performed.
Pre-Operative care
Before mandibular surgery, a plan is established together with all the specialists involved, so that everyone understands the goals, treatment, and care that is best suited for the patient. Before surgery, doctors usually advise patients the following:
- The patient should not eat or drink anything for at least 8-10 hours before surgery (excluding needed prescriptions).
- The patient should notify their doctor if any complications arise.
Procedure Type:
Surgical.
Post-Operative Care
The patient is kept in the Intensive Care Unit for at least 24 hours after surgery, post which they are transferred to a Step-Down care unit, if everything is normal. It usually takes five to ten days before the patient can be discharged with the help of family.
After surgery, it is expected to develop swallowing and difference in speech for which a speech therapist can be consulted. After surgery, food is provided by a feeding tube inserted through the nose and into the stomach (nasogastric/NG tube). It is critical to maintain proper nourishment and hydration post-op. A nurse can visit for a few weeks post-op.
Risks
There are some risks involved in a mandibulectomy like:
- Mild to severe bleeding, including hematoma, can be noted. If the patient bleeds profusely after the procedure, another surgery is performed right away to stop the bleeding.
- After a surgical drain is removed, a seroma may form in the neck, which is a collection of normal bodily fluid. The issue is not life-threatening and can be rectified.
- Blood clots: Patients may develop blood clots in their legs (deep venous thrombosis or DVT). If the clot migrates to other parts like the lung, it might be life-threatening, depending on the size of the clot.
- Infection: It is common in most surgeries. Antibiotics and/or drainage of the infection may be required.
Recovery
The length of recovery can only be determined by the level of complication and reconstruction. Some patients require physical therapy, or speech and swallowing therapy after the surgery for a proper rehabilitation process.
Doctors may wire the jaw closed to maintain the upper and lower teeth alignment. Pain medication can be given to relieve any pain if the patient complains of discomfort. The total recovery may take from a few weeks to months.
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