Maxillectomy (The James)

Maxillectomy (The James)

 

A maxillectomy is a surgery to remove part of the upper jaw and/or the teeth, palate. Reasons for this surgery may include:

  • Cancer or another type of tumor is in the upper jaw or the palate (roof of your mouth).
  • Osteoradionecrosis (ORN): condition where radiation causes damage to the tissue in the jaw. The damage can cause the tissue to die. The dead tissue needs to be removed.
  • Osteonecrosis: condition caused by infection or sometimes certain medicines that makes the upper jaw bone weak and may break.

 

You may be asked to see a special type of dentist called a prosthodontist. This dentist specializes in making special dentures or a mouth piece called an obturator. If part of the palate (roof of your mouth) is removed with surgery, this obturator will allow you to eat and drink without food or drink coming out of your nose.

Types of Free Flaps Used for a Maxillectomy

  • Fibular Flap (leg) - During surgery, tissue, blood vessels and a small piece of lower leg bone (fibula) are removed and used to rebuild the jaw. Taking out this bone and tissue does not affect your ability to walk or move. Skin will be removed from your upper leg to cover the area on your lower leg where the free flap was removed. When you wake up from surgery, there will be a dressing on your leg.
  • Scapular Flap (shoulder blade) - This type of free flap may be done when another area on the body cannot be used. Bone, tissue and blood vessels are removed from your shoulder blade to rebuild the jaw. You may need physical therapy after this type of surgery. Your doctor will order therapy if it is needed.
  • Forearm Flap (lower arm near your hand) - During surgery, bone, skin and a fat layer with blood vessels are removed from your lower arm. You will also have skin taken from your upper leg to cover the area on your lower arm where the free flap was removed. When you wake up from surgery, you will have a splint on your arm and a dressing on your leg.
  • Rotational flap could be used which means tissue is rotated into the area without disconnecting blood vessels to repair the area that is removed. This tissue would be from the head and neck area.
  • Other flaps or skin grafts can be used also. Please discuss these with your doctor.
  • Your medical doctor will do a physical exam to check your overall health before surgery.
  • You may be scheduled for tests such as a CT scan, electrocardiogram (EKG), chest x-ray, or blood work before surgery.
  • Do not use tobacco products 2 weeks before surgery and 6 to 8 weeks after your surgery. Tobacco products (cigars, cigarettes, chewing tobacco, or snuff) lower the amount of oxygen in your blood and decreases blood flow to your tissues. This may cause problems with healing and lung problems after surgery. Do not use a nicotine patch or nicotine gum because both of these products can cause a decrease in blood flow to the area where you will have surgery. The James has resources available to help you quit using tobacco, please let your team know how we can help you.

After Your Surgery

  • You will be in the hospital for about 7 to 10 days. Your doctor and nurses will keep a close watch on you and the incision areas where you had surgery.
  • A special machine called a Doppler will be used to check and make sure the incision areas are healthy.
  • Some flap sites need a drain (small tube with bulb on the end) to be placed during surgery. This allows drainage from the site to help with healing. You doctor will decide when the drain can be removed.
  • You may need a temporary feeding tube called a nasogastric tube (NG tube). This tube allows you to get liquid food while you are healing. The NG is placed through your nose while you are asleep in surgery. It will be removed when it is safe for you to eat and drink.
  • You will have a scar where the surgery is done. When cuts are made through the skin during surgery, it can leave a scar. Most scars fade over time.
  • You may need to take pain medicine after surgery. Pain medicine can slow down your bowel movements. Your doctor may have you take a stool softener or other medicines to help your bowels move after surgery.

Before You Leave the Hospital

  • You will be given instructions about how to take care of your wounds at home.
  • You will have a follow up appointment scheduled with your team 1 to 2 weeks after surgery. Your free flap will be checked at this appointment.

When to Call Your Doctor

Call your doctor if you have any of the following:

  • Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
  • Bleeding or drainage that has increased or changed
  • Foul smelling drainage from the incisions
  • Increased pain or pain not helped by medicine
  • Nausea or vomiting
  • Trouble with swallowing or eating

Call 911 and get emergency help right away if you have any of the following:

  • Chest pain
  • Trouble breathing
  • Bleeding that will not stop after holding firm pressure after 5 minutes

 

 

© September 13, 2023. The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.

This handout is for informational purposes only. Talk with your doctor or health care team if you have any questions about your care.