Surgical Procedures: Mandibulectomy

What is a mandibulectomy?

The mandible is the lower part of the jaw that moves. Surgery done to remove this part of the jaw is called a mandibulectomy. It can be used to treat oral cavity cancers (cancers inside the mouth).

There are two types of mandibulectomy:

• Marginal mandibulectomy: Only the area with cancer is removed. Much of the jawbone is left to try to avoid reconstructive surgery.
• Segmental mandibulectomy: The entire jawbone is removed and then reconstructed. A bone from another part of your body (leg, back, arm, or hip) is used to make a new jaw. This is called a “free flap.” Skin grafts and muscle flaps may also be used. An artery, vein, and some soft tissue will also be taken from another area and used for reconstruction.

Note: You may need a tracheostomy (tube/hole that lets you breathe through the neck), feeding tube, or to have your jaw wired closed for a short period of time depending on the surgery you have had. Your team will talk to you about the specifics of your surgery.

What are the risks of a mandibulectomy?

As with any surgery, there are risks and possible side effects. These can be:

• Bleeding.
• Hematoma (A collection of blood that will go away on its own or may need to be removed with surgery).
• Seroma (pocket of fluid).
• Infection.
• Blood clot.
• Salivary fistula (A hole causing saliva to leak from the mouth into the neck).
• A change in upper and lower tooth alignment (malocclusion).
• Trismus (having a hard opening the mouth).
• Nerve damage.

Before surgery, your provider will talk to you about any other risks, based on your health and the surgery you are having.

What is recovery like?

Recovery from a mandibulectomy depends on the procedure you have had. Often, you will be in the hospital for 10-14 days. In some cases, a temporary or permanent feeding tube is needed for nutrition during and after the healing process. This tube can go through your nose or may be placed through the abdominal (belly) wall into the stomach. Your jaw may be wired shut to keep the upper and lower teeth lined up. You may also need drains in the neck to let fluid drain out, a urinary catheter (to help you pee), and/or a tracheostomy.

You will be told how to care for your incisions (surgical cuts) and will be given any other instructions before leaving the hospital. You provider will talk to you about changes to your diet, caring for your feeding tube and/or tracheostomy, as well as the need for rehabilitative and/or speech therapy.

Your care team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention, and/or other conditions.

Your provider will talk to you about changes in your activity level, which depends on the surgery you had. Often, you should:

• Not use hot/cold compresses, hot water bottles, or heating pads on your incision. If nerves were damaged during surgery, you may not be able to feel extreme temperatures.
• Not use a sauna or steam room.
• Not shave your face until you are told that you can.
• Keep away from sun exposure until incisions are healed. If you will be in the sun, apply sunscreen to the incisions that is at least SPF 30 or higher and PABA-free.
• Not use scented lotions, perfumes, or colognes until you are told that you can.
• Resume showering, driving, and sexual activity when your surgical team tells you that you can.
• Not lift anything over 5 pounds for 6 weeks after your surgery.

What will I need at home?

• Thermometer to check for fever, which can be a sign of infection. Your care team will tell you at what temperature you should call them.
• Wound, drain, feeding tube, and tracheostomy stoma care supplies as needed.

When should I call my provider?

Your healthcare team will give you guidelines for when you should call the office. Often you should call you provider’s office if you have:

• A fever higher than 101°F/38.3°C.
• Pain, drainage, swelling, redness, and/or warmth at the incision site.
• Fluid building up under the incision.
• Shortness of breath.
• Any other new or worsening symptoms.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.