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Date issued:January 2024 

Review date: January 2026 

Ref: A-608/CP/Oncology/Maxillectomy

PDF: Maxillectomy final January 2024.pdf [pdf] 139KB

Information leaflet for patients, relatives and carers: Maxillectomy and Partial Maxillectomy

Introduction

This booklet aims to provide information about maxillectomy surgery, which may include one or a combination of the following operations:

• Partial maxillectomy to remove part of the maxilla

• Maxillectomy (removal of the whole maxilla) with bone or soft tissue reconstruction

• Maxillectomy with split skin graft and obturator

What is a maxillectomy?

The upper part of jaw is known as the maxilla. A maxillectomy is the surgical removal of part, or all, of the upper jaw, usually to treat a cancer. Your surgeon will also have to remove some healthy tissue around the edge of the 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 the roof of your mouth which will need to be sealed so that you can speak and swallow. 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 of this 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 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 at the same time.

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.

What is a split skin graft?

This is a patch of skin that is taken from another area of the body (normally thigh) and used to replace the tissue removed from the surgical site in the roof of your mouth. The site where the split skin graft is taken from is called a donor site. After your surgery, the donor site will be dressed and left covered for 2 weeks. At 2 weeks, this site will need to be checked by your GP practice nurse. They will guide you on further management.

What is an obturator?

An obturator is a special device made to fit your mouth. It works like a dental plate and provides a seal for the gap left in the roof of your mouth; it may also hold the skin graft in place whilst it heals. Prior to your surgery an impression will be taken so your obturator can be made ahead of time.

After about 2-3 weeks, you will need a further minor procedure under anaesthetic to remove the obturator, clean the cavity and adjust the fit. After this you will have several appointments with the restorative dentistry team who will ensure the obturator is fitting well. They will explain how to care for it. Eventually you will be able to remove and clean the obturator yourself.

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 the roof of your mouth. “Free flap” is the name given to tissue that is transferred from one part of the body to another. It is different to a skin graft as the vein and artery are transferred with the tissue. Your surgeon will decide which place is best to take the tissue from. Some of the common sites to use are taken from your arm, chest or leg. Your surgeon will explain this in detail before your surgery. 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 5-7 days.

Day 1

After your operation you may have the following:

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

• Urinary catheter to monitor your urine output

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

• Drains collecting fluid from your operation site in the neck if a neck procedure has been carried out

You surgeon many want you to be nil by mouth for a few days to rest the surgical area. When you surgeon is happy, they will begin to re-introduce oral intake.

Day 2

• Intravenous drips may be stopped, and your surgeon may be happy for you to commence sips of water

• Urinary catheter may be removed

• You will be encouraged and supported by our physiotherapy team to start mobilising as normal

Day 3

• If your surgeon is happy, you may be able to commence easy to swallow foods, such as custard, ice cream and soups.

• Once tolerating a good oral intake, preparation for discharge will commence.

It is important to understand that all 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 upper jaw is removed and how it is repaired. After surgery you will be swollen, your speech may sound different, and swallowing may feel strange. There may also be some discomfort, so ask the nursing team for pain relief. If you have an obturator, it can take some adjusting to optimise your speech and swallow.

The Speech and Language Therapist will help you:

• Understand the changes in your speech and swallow

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

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

The two main areas your therapist will focus on are:

Speech/Communication:

Your speech may sound more nasal, as if you have a cold. It usually sounds worse to you than it does to other people, this is because of how you hear yourself. Try to speak slowly, ensure you are facing the person and minimize background noise. The speech and language therapist can provide:

• Exercises to improve your speech

• Exercises to help maintain and improve jaw opening

Swallowing

Your therapist will assess you in hospital to check that your swallow is safe and help you with any changes 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