Your upper jaw is known as the maxilla. It acts as a seal for the roof of your mouth and has an important function with eating, drinking, and speaking.
Maxillectomy is the removal of all or part of the upper jaw, with or without removal of the teeth. Area of resection will leave a gap on the roof of the mouth. Your surgeon will discuss with you possible options to seal this gaps.
Option one – Fabricating a modified denture called an 'obturator' which fills the cavity created after the surgery. A temporary obturator is fixed in place during the surgery and it is kept in place during the first few weeks of healing. You will also need to have several follow-up appointments so that the obturator can be checked and adjusted to fit you comfortably. A final/ permanent obturator will be issued by the prosthodontist when all your wounds have healed.
Option two - Mobilising healthy tissues from another part of your body (for example, your forearm, hip or lower leg) to rebuild the part that has been taken away. This is called a free flap reconstruction. This type of operation may not be suitable for every patient who undergoes a maxillectomy.
Medial maxillectomy: The part of the maxilla that is next to the nose is removed.
Infrastructure maxillectomy: Removes the hard palate (roof of the mouth), lower part of the maxilla, and teeth.
Suprastructure maxillectomy: The upper part of the maxilla with or without orbital floor (bone below eye) is removed.
Subtotal maxillectomy: Removes only part of the maxilla using one of the above procedures.
Total maxillectomy: Removes the entire maxilla on one side (unilateral), as well as the hard palate and orbital floor.
Your surgeon may recommend you undergo maxillectomy for any of these reasons:
You have a benign tumour involving the maxilla or the maxillary sinus.
You have a confirmed diagnosis of cancer of the upper jaw, sinus or nose.
You have a bone infection that does not improve with medical therapy.
The surgery is performed under general anaesthesia. Depending on the size of the tumour, the surgery can be performed through the mouth (transorally) or by making an incision on the skin or endoscopically.
If the surgery is being done because there is a cancer or suspected cancer, your doctor may discuss with you about removing some of the lymph nodes in your neck as well (neck dissection).
If there is risk of airway swelling, your surgeon may decide to do a tracheostomy
There are risks and complications with this procedure. They include but are not limited to the following.
Common risks and complications include:
Pain and swelling
Bleeding- this can happen during or after surgery and rarely can be life-threatening
Infection
Loss of teeth in the removed part of jaw or damage to adjacent teeth
Changes to speech, swallowing and nasal breathing depending on which part of the maxilla is removed.
Cosmetic changes of the mid-face
Numbness of the remaining maxilla, nose, upper lip and cheek area
May need secondary revision or reconstruction of the area
Glue ear - congestion in their ear canal. This often resolves over time.
Patients will usually stay in the hospital for 1-2 weeks after their surgery.
After your surgery is done you will usually be sent to a recovery area in the operating theatre. When your condition is stable and you are fully awake you will be usually sent to High Dependency ward for close monitoring overnight.
It may be difficult for you to eat and drink after the surgery. Your surgeon may decide to place a nasogastric tube to facilitate feeding. The speech therapist will assess when it is safe to let you feed orally.
Some post-operative pain is expected. Your doctors will prescribe a combination of pain medications to help with that. If you still experience significant pain let the nursing staff know and they will contact your doctors to adjust your medication if necessary.
The physiotherapist will guide you to do deep breathing exercises and leg exercises. They will also assist in mobilising you when it is safe to do so.
It is alright to shower with soap and water but avoid scrubbing or excessive pressure over your surgical wound on your face and neck. After showering, pat the wound dry gently with a towel but do not rub the wound forcefully.
The dietitian will advise on feeding regime and if any special supplements are needed.
Avoid strenuous exercise or carrying heavy loads for the two weeks after surgery.
Standing and walking is alright.
Check with your doctor when it is okay to restart strenuous exercise.
Your doctor will usually prescribe you some medication to help with any pain you might have after the surgery. Take your medication as advised by your doctor. If you continue to have significant pain despite taking the medication, let your doctor or nurse know.
Seek medical attention if you have any of the following:
Fever (Temperature > 38 °C)
Increase redness and pain over your neck wound
Yellowish, foul-smelling discharge from the wound.
The surgical wound starts to open up.
Sudden swelling in the neck
Difficulty breathing.
Bleeding from the nose or oral cavity.
Your doctor may decide put a surgical drain in your neck at the time of surgery. This is a tube placed to remove excess fluid to prevent it from collecting in your neck. The nurses will teach you how to care for the drain and how to measure the output of the drain.
Your doctor will remove the drain once the amount coming out every day is minimal.
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