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Mandibulectomy


Medical editor Per Aspelien MD
Otolaryngologist
Oslo University Hospital

General

If tumor grows near the lower jaw with threatening infiltrations, it may be necessary to remove parts of the mandible. It is very important that the remaining lower jaw is well covered with tissue after the surgery due to the possibility of osteoradionecrosis after radiation therapy.

If the mandible cannot be covered with primary sutures of mucosa, a nasolabial flap is often used for coverage.  This means that skin and subcutaneous tissue flap is dissected from underlying facial muscles (1). A hole is made in the cheek to the mouth and the skin flap is pulled through and sutured to the edges of the mucosa . A free flap can also be used from the underarm.

Indication

  • Primary tumor situated near the mandible.

Goal

  • Resection of tumor

 

1. Refererence: Rökenes HK, Bretteville G, Lövdal O, Boysen M. The nasolabial skinflap in intraoral reconstruction. ORL J Otorhinolaryngol Realt Spec 1991; 53 (6): 346-8


Equipment

  • SSO tray (teeth/jaw)

Preparation

  • The surgery is performed under general anesthesia.
  • The patient lies supine.
  • The surgical field is shaved if necessary.

Implementation

  • Xylocain® with adrenaline is given.
  • Decaying teeth are extracted.

Because of the risk for osteoradionecrosis, extraction of teeth should be avoided in patients who have received radiation therapy. Decaying teeth are therefore extracted in advance. This is often combined with the surgical procedure. 

  • An incision is made through the mucosa toward the alveolar process.
  • The anterior part of the cranial mandible is removed with an oscillating saw at the level of the roots of the teeth.
  • Tumor is resected with a 1 cm macroscopic margin.
  • The specimen is removed en bloc and marked.
  • The mandible is well covered, possibly with use of a skin graft, or nasolabial flap. 
  • The incision is sutured. 
  • A nasogastric tube is inserted to relieve the incision. 

Follow-up

The patient will have a feeding tube for the first few days after the surgery. The length of time for this varies from patient to patient.


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