Mandibulectomy

Overview 

A mandibulectomy, or mandibular resection, is a surgical procedure that involves the removal of part or all of the lower jawbone, typically to excise a tumor or diseased tissue. This procedure can be classified as either partial or segmental, depending on the extent of the resection. In some cases, reconstruction of the jaw may be performed using bone from another area of the body. Recovery from a mandibulectomy can be lengthy, requiring time for surgical healing and, if reconstruction was done, adjustment to the newly reconstructed jaw.  

Types 

Mandibulectomy has two types:  

• Segmental mandibulectomy: This involves removing a large part of the jawbone and rebuilding it using bone, artery, vein, and tissue from another part of the body.  
• Partial mandibulectomy: This procedure usually removes only part of the jawbone, usually without needing reconstruction.  

Reasons for undergoing the procedure  

Recommending a mandibulectomy requires careful consideration of factors like other health conditions, the location and severity of the issue, and one’s overall health to ensure the best outcome.

It is often used to treat certain conditions, such as:  

• Major trauma to the jaw  
• Osteomyelitis, or bone infection  
• Oral or mouth cancer  
• Osteonecrosis, or severe jawbone damage resulting from bisphosphonate treatment  
• Oropharyngeal cancer, or Cancer in the middle part of the throat  

Risk 

As with any surgical procedure, mandibulectomy comes with possible complications, such as:  

• Infection 
• Damage to nerves 
• Formation of blood clots  
• Hematoma, or accumulation of blood beneath the skin  
• Seroma, or fluid collection under the skin 

Before the procedure  

Before the procedure, individuals may be advised to stop using certain substances and medications that can increase the risk of bleeding during surgery or hinder healing after the operation. These include alcohol, tobacco products, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements. 

Healthcare providers may also require imaging tests, such as computed tomography (CT) scans, to assess the size and extent of the tumor or affected area. If jaw reconstruction is necessary, additional tests may be performed to evaluate the condition of blood vessels at the bone donor site.

During the procedure  

A mandibulectomy is a lengthy surgery performed under general anesthesia. The procedure may involve using a bone from the one’s lower leg, shoulder blade, or hip. Alternatively, healthcare providers might use a metal plate or bone from a donor. 

Additional treatments along with the procedure may include arch bars to align teeth, a tracheostomy tube to assist breathing, and a feeding tube to ensure proper nutrition during recovery.

In a segmental mandibulectomy, the healthcare provider:  

• Excise a substantial portion of the jaw, including the tumor and adjacent tissues, and send the removed tumor and tissues for diagnostic analysis  
• Assess if cancer has spread to nearby lymph nodes  
• Extract bone, tissue, and skin from a donor site  
• Contour the harvested bone to replace the missing section of the jaw  
• Connect blood vessels from the donor site to those in the head and neck  
• Fix the reconstructed jaw with plates and screws and close the surgical sites

In a marginal mandibulectomy:  

• An incision is made in the inner cheek  
• The tumor is removed along with the surrounding soft tissue from the lower jaw  
• The incision is closed 

After the procedure  

After a mandibulectomy, the healthcare provider may recommend:  

• Physical therapy  
• Speech therapy  
• Radiation or chemotherapy, if cancer is confirmed 

The hospital stay after mandibulectomy can range from two days to two weeks, depending on the procedure. At home, one should follow their healthcare provider’s instructions for eating, wound care, and pain management, which may include a liquid diet or a feeding tube.  

Outcome 

During the recovery period, it is crucial to monitor for potential complications. Seek immediate medical assistance if you experience any of the following symptoms:  

• Difficulty breathing or shortness of breath  
• Swelling, particularly in the face or extremities  
• Fever  
• Nausea or vomiting  
• Rash 
• Persistent headache  
• Unusual or increased bruising  
• Increased irritability  
• Severe pain that does not improve with pain medication

Recovery from a mandibulectomy varies depending on the extent of the procedure. Most individuals can return to work within a few weeks, but it is advisable to wait longer before resuming strenuous activities. If reconstruction of the jaw was performed, therapy may be necessary to relearn how to swallow and eat effectively.