Your upper jaw is known as the maxilla. It acts as a seal for the roof of your mouth and has an important function with eating, drinking, and speaking.
Maxillectomy is the removal of all or part of the upper jaw, with or without removal of the teeth. Area of resection will leave a gap on the roof of the mouth. Your surgeon will discuss with you possible options to seal this gaps.
Option one – Fabricating a modified denture called an 'obturator' which fills the cavity created after the surgery. A temporary obturator is fixed in place during the surgery and it is kept in place during the first few weeks of healing. You will also need to have several follow-up appointments so that the obturator can be checked and adjusted to fit you comfortably. A final/ permanent obturator will be issued by the prosthodontist when all your wounds have healed.
Option two - Mobilising healthy tissues from another part of your body (for example, your forearm, hip or lower leg) to rebuild the part that has been taken away. This is called a free flap reconstruction. This type of operation may not be suitable for every patient who undergoes a maxillectomy.
Medial maxillectomy: The part of the maxilla that is next to the nose is removed.
Infrastructure maxillectomy: Removes the hard palate (roof of the mouth), lower part of the maxilla, and teeth.
Suprastructure maxillectomy: The upper part of the maxilla with or without orbital floor (bone below eye) is removed.
Subtotal maxillectomy: Removes only part of the maxilla using one of the above procedures.
Total maxillectomy: Removes the entire maxilla on one side (unilateral), as well as the hard palate and orbital floor.
Your surgeon may recommend you undergo maxillectomy for any of these reasons:
You have a benign tumour involving the maxilla or the maxillary sinus.
You have a confirmed diagnosis of cancer of the upper jaw, sinus or nose.
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 or endoscopically.
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
Changes to speech, swallowing and nasal breathing depending on which part of the maxilla is removed.
Cosmetic changes of the mid-face
Numbness of the remaining maxilla, nose, upper lip and cheek area
May need secondary revision or reconstruction of the area
Glue ear - congestion in their ear canal. This often resolves over time.