Mandibulotomy

What is Mandibulotomy

Mandibulotomy is a surgical procedure to cut the jawbone (mandible). This is done to gain better access to the mouth or throat. It is often done so that a cancerous tumor can be removed from the area. After the jawbone is cut, it is repaired with a metal plate and screws.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.
  • Whether you smoke or use tobacco products.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures or organs.
  • Loss of feeling around the mouth and lips.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicine

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
  • If you were prescribed an antibiotic medicine to help prevent infection, take it as told by your health care provider.

General instructions

  • Plan to have someone take you home from the hospital.
  • If you will be going home right after the procedure, plan to have someone with you for 24 hours.
  • Ask your health care provider how your surgical site will be marked or identified.
  • You may be asked to shower with germ-killing soap.
  • You may have blood or urine samples taken.
  • You may have imaging tests done, such as X-rays, CT scans, or MRIs.

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash and sanitize their hands.
    • Your skin will be washed with soap.
  • An IV tube will be placed in one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
  • A procedure called a tracheotomy may be performed to help you breathe. If you have this procedure, an incision will be made in your neck and a breathing tube will be inserted through the incision.
  • An incision will be made down the middle of your lower lip and chin.
  • Your cheek tissue will be lifted.
  • A metal plate will be fitted to the area of your jawbone that will be cut.
  • In the remaining part of the jawbone, holes will be drilled for the screws that will hold it in place.
  • A cut will be made in the jawbone using a small surgical saw.
  • The jawbone will be separated.
  • Some muscles and tissue in the area will be moved out of the way.
  • The cancerous tumor and tissues will be removed.
  • Soft tissue that was cut to remove the tumor will be closed with stitches (sutures).
  • The jawbone will be placed back in position.
  • The plate will be screwed in to secure the jawbone.
  • The incisions will be closed with sutures. In some cases, skin from another part of the body may be used (skin graft) to replace diseased skin. Tissue and blood vessels from another part of the body may also be used (flap procedure).
  • A bandage (dressing) may be placed over the incision.

This procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • A tube may be placed through your nose to help provide nutrients while you recover (nasogastric tube). It will be removed before you leave the hospital.
  • You may need to stay in the hospital for a number of days. While you are in the hospital, IV tubes may be inserted in your veins to provide fluids and medicines.
  • You will be given pain medicines and antibiotics.
  • Ice packs may be placed around your jawbone to reduce swelling.
  • A feeding tube may be inserted into your stomach (gastrostomy). You may need to use the tube for a few weeks.
  • If you do not have a feeding tube, you will need to follow a liquid-only diet for the first few days after surgery.
  • You may have swallowing and speech therapy.
  • Do not drive for 24 hours if you were given a sedative.

Summary

  • Mandibulotomy is a surgical procedure to cut the jawbone (mandible). This is done to gain better access to the mouth or throat.
  • This procedure is often done to remove a cancerous tumor.
  • Generally, this is a safe procedure. However, problems may occur, including infection, bleeding, allergic reactions, damage to other structures or organs, and loss of feeling around the mouth and lips.
  • You may need to stay in the hospital for a number of days, and you may have IV tubes or a feeding tube inserted to provide fluids and medicines.

Mandibulotomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Pain and swelling around the mouth and jaw.
  • Nausea.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Take your antibiotic medicine as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.
  • To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
    • Drink enough fluid to keep your urine clear or pale yellow.
    • Take over-the-counter or prescription medicines.
    • If your diet allows, eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
    • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

Eating and drinking

  • Follow instructions from your health care provider about eating or drinking restrictions. You may be told to:
    • Follow a liquid-only diet for the first 48 hours after surgery.
    • Follow a soft-food diet for the first 2 weeks after surgery.

Driving

  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not drive for 24 hours if you were given a medicine to help you relax during the procedure (sedative).

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider when it is okay for you to shower.
  • Maintain good oral hygiene. This includes:
    • Using a mouth rinse as told by your health care provider.
    • Brushing regularly with a soft toothbrush. Avoid heavy brushing against the incision area.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
  • Check your incision area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • Fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Activity

  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that your health care provider tells you, until he or she says that it is safe.
  • Avoid activities that require a lot of effort (are strenuous) as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

  • Sleep with your head raised higher than your chest for the first 4 or 5 days. Prop up your head on two or three pillows or sleep in a recliner.
  • If you have a feeding tube in placecare for it as told by your health care provider. You may need to wash the skin around the tube regularly.
  • Follow instructions from your health care provider about drain care. Make sure you empty the drain at least two times a day.
  • Participate in swallowing and speech therapy as told by your health care provider.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have more redness, swelling, or pain around any incision.
  • You have fluid or blood coming from any incision.
  • Any incision feels warm to the touch.
  • You have pus or a bad smell coming from any incision.
  • You have a fever.
  • Your pain does not improve.
  • Your nausea does not improve.
  • You have trouble eating.
  • You have trouble talking or swallowing.

Get help right away if:

  • You have severe pain that is not controlled with medicine.
  • You cannot move your mouth or jaw.
  • You have trouble breathing.

Summary

  • After the procedure, it is common to have nausea and to have pain and swelling around the mouth and jaw.
  • Maintain good oral hygiene during recovery. This may include using a mouth rinse and brushing regularly with a soft toothbrush. Avoid heavy brushing against the incision area.
  • Follow instructions from your health care provider about eating or drinking restrictions. You may be told to follow a liquid-only diet for the first 48 hours after surgery and a soft-food diet for the first 2 weeks after surgery.
  • If you have a feeding tubecare for it as told by your health care provider. You may need to wash the skin around the tube regularly.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
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