The mandible is the lower jaw. Mandibulectomy is a surgical procedure to remove a portion of the mandible while treating oral cavity cancer.
There are two types of mandibulectomy:
- Marginal mandibulectomy: It involves only the removal of the cancerous area. There is no need for reconstructive surgery because a majority of the jaw is left.
- Segmental mandibulectomy: It involves the removal of the entire jaw. The jaw needs reconstruction after the procedure. For reconstruction, the bone from the leg, back, arm, or hip is taken to make a new jaw.
Marginal mandibulectomy should be avoided when:
- The surgeon is not sure how much the cancer has invaded the bone.
- The patient has uncorrected coagulopathy (impaired blood clotting).
- The patient has heart disease.
When is marginal mandibulectomy indicated?
Marginal mandibulectomy is indicated in the following conditions:
- A tumor that has spread near the jawbone but has not yet invaded it.
- Osteonecrosis (loss of blood flow to the bone tissue) of the mandible due to bisphosphonates (a type of medicine).
- Osteoradionecrosis (bone death) of the jaw following head and neck radiotherapy.
What are the risks of marginal mandibulectomy?
Mandibulectomy isn’t short of risks and possible side effects. Some of the most common risks and possible side effects include:
- Blood clot
- Bleeding
- Hematoma (pooling of the blood)
- Seroma (pocket of fluid)
- Infection
- Salivary fistula (a hole causing the saliva to leak from the mouth into the neck)
- Malocclusion (changes in the alignment of the upper and lower tooth)
- Trismus (difficulty in opening your mouth)
- Nerve damage
What to expect during a marginal mandibulectomy?
Before the procedure
You will be given specific instructions regarding what to do before the surgery. Some of the instructions include:
- You should not eat or drink anything for 6 hours before the surgery.
- Avoid using blood thinners, such as Warfarin or Aspirin, a week before the surgery.
- Refrain from smoking before the procedure.
You can also expect the following things:
- Taking photographs of your face for reconstruction
- Undergoing an angiogram, magnetic resonance imaging (MRI), or computed tomography (CT) scan
- Some of your teeth may be extracted during the procedure
- Your surgeon will detail the procedure during an appointment
- You should seek advice from the physician regarding lifestyle modifications
During the procedure
You will be given general anesthesia and made to sleep throughout the procedure. The physician performs marginal mandibulectomy by:
- Making an incision at the affected side of the lower lip or cheek
- Removing the tumor and the surrounding soft tissues
- Preserving the inferior border of the jawline to retain the bone strength for chewing
- Closing the incisions
After the procedure
You can expect the following after the surgery: