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Date issued: January 2024 

Review date: January 2026

Ref: A-609/CP/Oncology/ Mandibulectomy

PDF: Mandibulectomy final January 2024.pdf [pdf] 127KB

Information leaflet for patients, relatives and carers: Mandibulectomy (partial or total)

Introduction

This booklet aims to provide information about mandibulectomy surgery, which may include:

• Total mandibulectomy

• Partial mandibulectomy

The area that is removed will be reconstructed and is replaced with either:

• A muscle and skin flap, or

• A combination of metal plate, skin, muscle and/or bone flap

What is a Mandibulectomy?

A mandibulectomy is the surgical removal of part of your lower jaw. How much of your lower jaw is removed depends on the size of your cancer and the location. Your surgeon will also have to remove some healthy tissue around the edge of your tumour. This helps reduce the risk of any cancer cells being left behind. The surgery may also include the removal of teeth.

The operation will leave you with a gap in your lower jaw and this will need to be replaced to help restore your ability to speak and swallow and keep your jaw strong. It will also help to restore your appearance as much as possible. There are several different ways your surgeon can do this, but they will choose the best method for you.

Your surgeon will send your tumour to the laboratory for analysis after your surgery. The results will be discussed amongst the multi-disciplinary team, which includes several surgeons, oncologists and members of your head and neck support team. They will determine if you require any further treatment after your surgery.

Your surgeon may decide that you need a neck dissection (an operation to remove the lymph nodes in your neck). This is to check for potential spread of cancer cells or to treat lymph nodes that look suspicious for cancer. This will also be sent to the laboratory and analysed.

Your individual treatment will be carefully planned by your surgical and oncological teams. This leaflet is a general guide to cover all options. We will provide information about your specific treatment needs as appropriate.

Advanced Reconstruction

This uses tissue and/or bone from another area of the body, to assist your surgeon with their reconstruction and to help fill the gap in your lower jaw. “Free flap” is the name given to tissue that is transferred from one part of the body to another, the vein and artery are also transferred with this tissue. Your surgeon will decide which place is best to take the tissue from and what is the most appropriate type of reconstruction for you.

Methods of Reconstruction

This may include a combination of:

• Metal plate, this will be made ahead of time to help reconstruct your jaw

• Bone graft, the most common sites to use are taken from your hip (iliac crest). This will also be used to help with the reconstruction of your jaw

• Free flap, this is used to help cover your jaw and fill any deficit around the surgical area that is still exposed. Common sites to use are from your hip, leg and arm

• Rotational flap, this can also be used to help cover any plate used to reconstruct the jaw. A muscle from your chest (pectoral muscle) is common.

Your head and neck team can provide additional appointments to discuss your surgery in more detail if required.

Your Hospital Admission

The average length of stay is usually between 7 to 14 days.

Day 1

After your operation you may have the following:

• An intravenous drip to give you pain relief and additional fluids if required

• Urinary catheter to monitor your urine output

• Nasogastric feeding tube, which is placed though your nose and into your stomach to provide nutrition, hydration and medication administration

• Tracheostomy in your neck to help with your breathing as you may be swollen (removed when swelling reduces).

• Drains collecting fluid from your operation site in your neck

Your surgeon will want you to be nil by mouth until they are happy that the reconstructed site in your mouth is healthy and healing. When your surgeon is happy, they will begin to re-introduce oral intake.

Day 2

• You will be encouraged and supported by our physiotherapy team to sit in the chair.

• Most things will remain the same as day 1, but you will start feeling more alert.

Day 3-5

• Your catheter, drains and intravenous drips may start to be removed

• If you have a tracheostomy, this may be removed

• The physiotherapy team will help you increase your mobility as appropriate

• Your surgeon may want to re-introduce oral intake

It is important to understand that all of the above may vary depending on individual circumstances and rate of recovery.

Your Clinical Nurse Specialists, Speech and Language Therapist, Dietitian and Support Worker will regularly visit you on the ward to monitor your progress and work closely with the ward team to co-ordinate your surgical plans and care.

How can Speech and Language Therapy help me?

The effects of this surgery on your speech and swallow depend on how much of your lower jaw is removed and how it is repaired. After your surgery you will be swollen, so this will also have an impact on both functions.

The Speech and Language Therapist will help you:

• Understand the changes with your speech and swallow

• Offer advice and support to help you adapt to these changes

• Provide you with the support and advice once you go home, if required

The two main areas your therapist will focus on are:

Speech/Communication:

• Exercises to improve speech

• Exercise to help maintain and improve jaw opening

Swallowing

Your therapist will assess you in hospital to check that your swallow is safe and help with any changes that you are experiencing. They may advise you on various head positions and different techniques to make swallowing easier and safer. They will also advise you on types of foods and consistencies that are easier for you to swallow.

How can the Dietitian help me?

Directly after surgery you may be nil by mouth and fed via a nasogastric tube. This is a thin tube passed through your nose into your stomach. The Dietitian will ensure that your individual nutritional requirements are met. They will formulate a feeding regime that the ward staff will follow whilst you are in hospital. As you start to re-introduce oral diet, they will monitor you and ensure you are getting enough calories, protein and fluid. They may give you high calorie supplements to help meet your requirements.

Your head and neck support team here at Derriford Hospital:

Mr McArdle: Maxillo Facial Consultant Surgeon

Secretary: 01752 431623

Stephanie Murgatroyd & Claire Percival: Clinical Nurse Specialists: 01752 430279

Chloe Tremlett: Specialist Speech and Language Therapist: 01752 439826

Specialist Dietitian: 01752 432247

Lisa Peters: Support worker: 01752 430279

Useful Resources

The Mustard Tree Cancer Support Centre

Level 3

Derriford Hospital

Plymouth

PL6 8DH

01752 430279

Changing Faces: www.changingfaces.org.uk

Compiled by Claire Percival

Head, Neck and Thyroid Oncology Clinical Nurse Specialist