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Mandibulectomy

ISSN 2398-2950


Introduction

  • Mandibulectomy performed for surgical treatment of neoplasia involves resection of lower jaw bone with surrounding soft tissue in order to accomplish margins free of tumor cells.
  • Various mandibulectomy procedures are possible:
    • Partial resection of the mandible on one or both sides (unilateral or bilateral rostral mandibulectomy and partial mandibular body resection).
    • Resection of one entire mandible (total mandibulectomy).
    • Resection of one entire mandible and a portion of the mandible on the other side.
    • Resection of the mandibular ramus or a portion of it.

Uses

  • Neoplasia affecting the lower jaw (ie one or both mandibles and adjacent soft tissues).
  • Jaw fractures Mandible: fracture involving a rostral segment.

Advantages

  • Curative surgery in the case of neoplasia.
  • Simple solution for jaw fracture management in select cases.
  • Bilateral rostral mandibulectomy to the level of the first premolars provides good function and aesthetics. Resection of the mandibular symphysis causes the two remaining mandibular sections to ‘float,’ which is functionally and esthetically acceptable.

Disadvantages

  • Bilateral resection caudal to the mandibular symphysis results in progressively greater problems with tongue and saliva retention, eating, drinking, and grooming.
  • Shifting of the opposite mandible toward the site of surgery in select cases (impinging of mandibular teeth onto hard palate mucosa).

Technical problems

  • Proximity of the sublingual caruncles (opening of the ducts of the mandibular and sublingual salivary glands).
  • Inferior alveolar neurovascular bundle in the mandibular canal.
  • Access to the caudal mandible (inferior alveolar neurovascular bundle entering the mandibular foramen, muscular attachments at angular process and coronoid process).

Alternative techniques

  • Non-surgical management of oral neoplasia (radiation therapy, chemotherapy, immunotherapy, etc).

Time required

Preparation

  • Depending on diagnostic procedures (radiography, computed tomography) performed (0-45 min).
  • Patient positioning, surgical site preparation, draping (10-15 min).

Procedure

  • Depending on the type of mandibulectomy procedure performed (1.5-5 hours).
  • Rule of thumb is that wound closure takes as long as the actual mandibulectomy.

Requirements

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Preparation

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Technique

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed papers

Other sources of information

  • Lewis J R (2015) Oral tumors, benign. In: Clinical Veterinary Advisor, Dogs and Cats. Cote E. 3rd edn. St. Louis: Elsevier, pp 725-727.
  • Lewis J R (2015) Oral tumors, malignant. In: Clinical Veterinary Advisor, Dogs and Cats. Cote E. 3rd edn. St. Louis: Elsevier, pp 727-730.