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Surgical Procedures: Maxillectomy What is a maxillectomy and how is it performed? A maxillectomy is a surgical procedure that is done to remove all or part of the upper portion of the jaw, otherwise referred to as the maxilla, for certain medical conditions including cancer of the oral cavity, nasal cavity and/or maxillary sinuses. It may be used for other tumors or medical conditions. There are several different types of maxillectomy, including: ●
Medial maxillectomy: During a medial maxillectomy the eye and the hard palate (roof of mouth) are spared, however, a portion of the maxilla that is near the nose is removed. This procedure may be performed in one of two ways, including an open incision or through the nostril. Typically, patients undergoing this procedure do not require reconstructive surgery.
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Infrastructure maxillectomy: An infrastructure maxillectomy, removes the hard palate (roof of the mouth), lower portion of the maxilla and teeth. This procedure does not require the removal of the orbital floor (bone below eye), however, reconstructive surgery is typically necessary.
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Suprastructure maxillectomy: During a suprastructure maxillectomy, the upper portion of the maxilla and orbital floor (bone below eye) is removed, however, the orbit (bone around eye) itself may be left in place in certain circumstances. Due to the removal of the eye, reconstructive surgery is required.
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Subtotal maxillectomy: A subtotal maxillectomy will remove only a portion of the maxilla using some variation of the above procedures.
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Total maxillectomy: A total maxillectomy will remove the entire maxilla on one side (unilateral) as well as the hard palate and orbital floor (bone below eye). Due to the radical nature of the procedure, major reconstructive surgery, possibly with prosthetics, will be required.
Note: In some cases, chronic tearing is a problem for patients depending on the surgery they have undergone. Your surgeon will discuss the need for a nasolacrimal apparatus to prevent the condition. In addition, other surgical procedures may be required, including skin grafting, the placement of a tracheostomy, and/or feeding tube. Some of these procedures may require the use of prosthetic devices, like an obturator, to fill in the roof of the mouth from where bone was removed and allow for eating, speaking and swallowing. This prosthetic device is also used to keep skin grafts in place when necessary.
What are the risks associated with a maxillectomy? As with any surgical procedure, there are risks and side effects associated with undergoing a maxillectomy. Risks and side effects associated with maxillectomy may include:
OncoLink is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through OncoLink should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem or have questions or concerns about the medication that you have been prescribed, you should consult your health care provider.
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Anesthesia related complications
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Bleeding
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Hematoma
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Infection
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Blood clots, including a pulmonary embolus
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Enophthalmos (a condition when the eye sinks into the cheek)
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Nerve damage causing numbness in the cheek
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Numbness or weakness
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Epiphora (chronic eye tearing)
Other risk factors are determined based on your health status and procedure being performed. Speak with your surgeon about the specific risk factors present in your case.
What is recovery like? Recovery from a maxillectomy will depend on the extent of the procedure performed. Typically, one to two week hospital stay is required. In certain situations, a temporary feeding tube may be required to provide you with nutritional support during and after the healing process. You will be instructed on how to care for your surgical incisions and will be given any other instructions prior to leaving the hospital, such as the need for dietary modification, feeding tube care, tracheostomy care, as well as the need for rehabilitative and/or speech/language therapy. Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, constipation prevention and/or other conditions. Your healthcare team will discuss your postoperative activity restrictions and need for follow up care. Typically it is recommended that you: ●
Avoid strenuous activity for 2 weeks following surgery or until approved by your surgical team. This includes bending, lifting and/or straining.
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Advance your diet as directed. If you are able to eat and drink, it is typically recommended that you avoid hot food/liquids because of the potential for facial numbness.
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Shower as directed.
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Brush teeth as directed. It is typically recommended that you brush your teeth with a soft toothbrush and perform saline irrigations of the nasal cavity as directed.
What will I need at home? ●
Thermometer to monitor for infection.
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Wound, feeding tube and tracheostomy stoma care supplies as needed.
When to Call Your Doctor OncoLink is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through OncoLink should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem or have questions or concerns about the medication that you have been prescribed, you should consult your health care provider.
Information Provided By: www.oncolink.org | © 2017 Trustees of The University of Pennsylvania
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Your healthcare team will provide you with specific guidelines of when to call the office, however typically it is recommended to call you surgeon’s office if you experience: ●
Difficulty breathing
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Fevers of >101° F
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Increasing swelling
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Pain unrelieved with pain medication
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Any questions or concerns you may have
Your healthcare team will provide you with detailed instructions on when to call them and/or when an emergent evaluation with emergency services is warranted.
How Can I Care for Myself? Depending on the extent of your surgery, you may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team gives you the go ahead to resume normal activity. Be sure to take your medications as directed to prevent pain, infection and/or constipation and call your medical team with any concerning symptoms. If you experience constipation, speak with your healthcare team to determine how to best treat this side effect of treatment and medication use. Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense. A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders. Find more relaxation exercises on OncoLink. This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.
OncoLink is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through OncoLink should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem or have questions or concerns about the medication that you have been prescribed, you should consult your health care provider.
Information Provided By: www.oncolink.org | © 2017 Trustees of The University of Pennsylvania
