What Is a Marginal Mandibulectomy and What to Expect

Marginal mandibulectomy is a surgical procedure that involves removing a specific section of the lower jawbone, known as the mandible. It addresses conditions affecting the jaw by removing diseased tissue while preserving the jawbone’s continuity and function.

Purpose of Marginal Mandibulectomy

Marginal mandibulectomy is primarily performed to treat certain oral cancers that affect the jawbone or nearby soft tissues, particularly when the bone involvement is superficial. This procedure is considered when a tumor is located close to or abuts the mandible, but has not deeply invaded the bone itself. The goal is to remove the cancerous tissue while leaving the main structure of the mandible intact.

The procedure also addresses less common conditions such as benign tumors or cysts within the mandible that necessitate bone removal. This approach differentiates it from more extensive resections, where a larger segment of the jaw might be removed, potentially disrupting its continuity.

Overview of the Procedure

The procedure begins with pre-operative planning, including detailed imaging like CT scans and MRIs to map the area for resection and determine the extent of bone removal. Patients receive general anesthesia for comfort throughout the several-hour operation.

The surgeon makes an incision to access the jawbone, often through the inner cheek or a small external incision to minimize visible scarring. Using a saw, a rim or section of the outer or inner cortical bone, or a segment of the alveolar process, is carefully removed. After the diseased tissue and a surrounding margin of bone are removed, the soft tissues are closed, and immediate reconstruction with local flaps or a skin graft may be performed.

Recovery and Post-Operative Care

Following a marginal mandibulectomy, patients can expect some swelling and discomfort, which is managed with pain medication. Drainage tubes may be placed in the neck to help remove accumulated fluid and prevent infection. The typical hospital stay can range from a few days to about two weeks, depending on the extent of the surgery and individual healing.

Initial dietary modifications are common, starting with clear, cool liquids and gradually progressing to soft or pureed foods as tolerated. Patients are advised to avoid hot liquids or foods initially to prevent bleeding and burns in numb areas of the mouth. Temporary side effects like numbness, difficulty speaking, or jaw stiffness may occur. Oral hygiene instructions are provided to maintain cleanliness at the surgical site. Regular follow-up appointments are scheduled to monitor wound healing and overall progress.

Life After Marginal Mandibulectomy

After the initial recovery phase, individuals typically experience a good functional and aesthetic outcome due to the preservation of jaw continuity. However, some long-term changes in sensation, chewing ability, and speech may persist, though often less severe than with more extensive jaw resections. Patients may find their food mixing ability reduced, especially if the resection was accompanied by a glossectomy.

Rehabilitation, which may include physical therapy or speech therapy, can help improve jaw movement, speech clarity, and swallowing function. Speech and swallowing rehabilitation can significantly improve the quality of life, with improvements observed in jaw movement, lip control, and tongue range. For those who underwent surgery for cancer, ongoing surveillance with regular check-ups and imaging is important to monitor for any recurrence. Psychological adaptation to changes in appearance or function is also a part of the long-term journey, with many patients achieving satisfactory quality of life.

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