Mandibulectomy

Mandibulectomy (MAN-dih-bul-EK-toh-mee) is surgery that removes a small or large part of your lower jawbone (mandible). Often, surgeons perform a mandibulectomy to remove a tumor or diseased section of your jaw. This procedure is also called mandibular resection.

You may need a mandibulectomy procedure if you have:

• Cancer in your mouth
• Cancer in your oropharynx, or middle part of your throat
• Infection in your jawbone
• Severe bone disease (osteonecrosis of the jaw) that develops from cancer therapy, including some medicines and radiation therapy (osteoradionecrosis)
• Significant injury to your jaw

Afterward, your surgeon may reconstruct your jaw. To do this, they may take bone or soft tissue from another part of your body to make a new lower jaw. Often, it’s your lower leg, shoulder blade or hip. They may also use a metal plate or piece of bone from a donor.

Types

There are two types of mandibulectomy:

• Partial mandibulectomy (marginal mandibulectomy): Your surgeon only removes part of your jawbone. You may not need reconstructive surgery.
• Segmental mandibulectomy: Your surgeon removes a large part of your jawbone and rebuilds your jaw. Typically, surgeons use bone, an artery, a vein and soft tissue from the small bone in your lower leg called the fibula. It’s called free fibular flap reconstruction.

The procedure you need depends on lots of things, including the extent of cancer spread in your jawbone. Your general health and preferences also matter.

How should I prepare for this procedure?

Before a mandibulectomy, your healthcare providers will use several tests, like a CT scan and MRI, to evaluate the area.

If you need reconstructive surgery to rebuild your jaw, your care team will check the health of blood vessels in the body part they’re taking bone from (donor site).

They may suggest changes to your routine related to eating habits and exercise to get you in good shape for surgery. You may need to avoid certain substances that can cause bleeding during surgery or interfere with healing, including:

• Alcohol
• Aspirin, naproxen or ibuprofen
• Herbal supplements
• Tobacco

What happens during this procedure?

A mandibulectomy is a major surgery that takes many hours. Before it starts, you’ll receive general anesthesia to put you to sleep. Your care team will attach you to an IV, so you can get nutrition and pain medicine. You’ll also need a foley catheter to pee and a breathing tube to get air.

During a marginal mandibulectomy, your surgeon:

1. Makes a cut (incision) through your inner cheek
2. Removes the tumor and surrounding soft tissue from your lower jaw
3. Closes the incisions

During a segmental mandibulectomy, your surgical team removes a larger portion of your jaw. Then, they rebuild it. Often, these procedures happen back-to-back. But sometimes, they need to happen on different days. Typically, the team:

1. Removes the tumor and surrounding tissues
2. Sends the tumor and tissues to a lab to test for cancer cells
3. Checks whether cancer has spread to your lymph nodes
4. Removes bone, tissue and skin from the donor site (usually your fibula)
5. Shapes the bone to match the missing piece from your jaw
6. Connects the artery and vein from the donor site to an artery and vein in your head and neck
7. Attaches the new jaw with plates and screws and closes the incisions

Your provider may also add dental implants the day of your surgery.

What are the potential benefits and risks of this procedure?

Any surgery comes with potential risks, like:

• Blood or fluid buildup under your skin
• Blood clots
• Infection
• Nerve damage

That said, these complications aren’t common. And most people have an improved quality of life after the procedure. In addition to getting rid of the cancer, jaw reconstruction can allow you to continue eating and talking. It may help you feel more confident about your appearance.

What happens after this procedure?

You’ll likely wake up in the intensive care unit (ICU) with drains in your jaw and at the donor site to help the wounds heal. You may need an oxygen mask to help you breathe. Your care team will monitor you. Once you’re ready, they’ll move you to a room.

Most people stay in the hospital for a week or two, depending on the procedure.

How long does it take to recover from a mandibulectomy?

Recovery from a mandibulectomy can take time. It begins in the hospital and continues at home. While you’re in the hospital, your care team will help you:

• Communicate: You may not be able to speak at first. Your care team will give you a pad to write on or ask yes-or-no questions so you can communicate during this time.
• Eat: You’ll eat through a feeding tube in your nose or belly. Gradually, you’ll switch to oral feedings. You’ll start with a liquid diet and then progress to soft foods.
• Exercise: Your providers will encourage you to walk when it’s safe to do so. Movement helps you heal and can prevent blood clots. It can get your digestive system up and running so you don’t become constipated.

Many people start physical therapy and speech therapy while they’re still in the hospital. You’ll likely continue therapy once you go home. These treatments help you eat, swallow and speak after surgery.

Once you’re home, follow your provider’s instructions on eating and caring for your incisions.

You’ll also discuss how best to manage pain after surgery. It’s not uncommon to have soreness, tightness or heaviness in your jaw several months after surgery. But for most people, the pain gradually decreases to discomfort before eventually going away.

How does a mandibulectomy affect eating?

This surgery impacts the muscles that connect to your jaw. This includes the ones that help you eat. At first, eating can be hard because these muscles have to heal. This is why you may need a feeding tube at first. You’ll likely have to work with a healthcare provider to retrain the muscles so they work again.

Things can feel frustrating for a long time before they start to get better. But with hard work and patience, many people eventually progress from liquids to soft foods to their regular meals and snacks.

When can I return to work and other activities after this procedure?

You can typically return to work after several weeks. You may need to wait longer before doing any strenuous activities, like exercise. Related, it may take longer to return to a physically demanding job than a desk job.

Still, much depends on your situation. For example, many people get radiation therapy after a mandibulectomy to get rid of any remaining cancer cells. This can extend your recovery timeline and the time you’ll need to rest.

Your surgical team will tell you when you can resume your routine based on your treatment plan.

When should I call my healthcare provider?

Let your provider know if you develop:

• Fever above 100.5 degrees Fahrenheit (38.05 degrees Celsius)
• Increased bruising
• Nausea or vomiting
• Severe pain that doesn’t go away with a pain reliever
• Shortness of breath or trouble breathing
• Swelling, warmth or bad-smelling drainage where the incision is