Your lower jaw is known as the mandible. Mandibulectomy is the removal of all or part of the lower jaw, with or without removal of the teeth. Area of resection may leave a gap in the jaw bone and floor of the mouth. Your surgeon will discuss with you possible options to reconstruct these gaps.
Option one – Primary closure. Where the remaining soft tissue is stitched together to reduce the size of the wound defect and avoid communication of the oral cavity to neck space.
Option two - Mobilising healthy tissues from another part of your body (for example, your forearm, hip, thigh or lower leg) to rebuild the part that has been taken away. This is called a free flap reconstruction. Free flap reconstruction can be done using only soft tissue to fill the defect and seal the oral cavity. The remaining segments of the mandible may be held in place with a titanium plate or with a free flap with bone.
Your surgeon will explain the possible options for feasible for your case.
Types of Mandibulectomy:
Marginal mandibulectomy: The inferior border of the mandible is left intact preserving the continuity of the mandible.
Segmental mandibulectomy: A segment of lower jaw with/ without jaw joint is resected. This usually requires reconstruction to maintain the jaw function and preserve the shape of the lower face.
Your surgeon may recommend you undergo mandibulectomy for any of these reasons:
You have a benign tumour involving the lower jaw.
You have a confirmed diagnosis of cancer of the lower jaw, tongue or oral tissues close to your lower jaw.
You have a bone infection that does not improve with medical therapy.
The surgery is performed under general anaesthesia. Depending on the size of the tumour, the surgery can be performed through the mouth (transorally) or by making an incision on the skin.
If the surgery is being done because there is a cancer or suspected cancer, your doctor may discuss with you about removing some of the lymph nodes in your neck as well (neck dissection).
If there is risk of airway swelling, your surgeon may decide to do a tracheostomy.
There are risks and complications with this procedure. They include but are not limited to the following.
Common risks and complications include:
Pain and swelling
Bleeding- this can happen during or after surgery and rarely can be life-threatening
Loss of teeth in the removed part of jaw or damage to adjacent teeth. You may also have a change in your bite or the way your teeth align.
Changes to speech and swallowing depending on which part of the mandible is removed.
Cosmetic changes of the lower face.
Numbness of the lower lip/ chin area. Rarely numbness of the tongue and change in taste sensation on the operated side.
May need secondary revision or reconstruction of the area
Trismus: tightness of jaw muscles and opening jaw wide
Patients will usually stay in the hospital for 1-2 weeks after their surgery.
After your surgery is done you will usually be sent to a recovery area in the operating theatre. When your condition is stable and you are fully awake you will be usually sent to High Dependency ward for close monitoring overnight.
It may be difficult for you to eat and drink after the surgery. Your surgeon may decide to place a nasogastric tube to facilitate feeding. The speech therapist will assess when it is safe to let you feed orally.
Some post-operative pain is expected. Your doctors will prescribe a combination of pain medications to help with that. If you still experience significant pain let the nursing staff know and they will contact your doctors to adjust your medication if necessary.
The physiotherapist will guide you to do deep breathing exercises and leg exercises. They will also assist in mobilising you when it is safe to do so.
It is alright to shower with soap and water but avoid scrubbing or excessive pressure over your surgical wound on your face and neck. After showering, pat the wound dry gently with a towel but do not rub the wound forcefully.
The dietitian will advise on feeding regime and if any special supplements are needed.
Avoid strenuous exercise or carrying heavy loads for the two weeks after surgery.
Standing and walking is alright.
Check with your doctor when it is okay to restart strenuous exercise.
Your doctor will usually prescribe you some medication to help with any pain you might have after the surgery. Take your medication as advised by your doctor. If you continue to have significant pain despite taking the medication, let your doctor or nurse know.
Seek medical attention if you have any of the following:
Fever (Temperature > 38 °C)
Increase redness and pain over your neck wound
Yellowish, foul-smelling discharge from the wound.
The surgical wound starts to open up.
Sudden swelling in the neck
Bleeding from the oral cavity.
Your doctor may decide put a surgical drain in your neck at the time of surgery. This is a tube placed to remove excess fluid to prevent it from collecting in your neck. The nurses will teach you how to care for the drain and how to measure the output of the drain.
Your doctor will remove the drain once the amount coming out every day is minimal.