Mandible Reconstruction

What is a Mandibulectomy and Free-Flap Reconstruction

During a mandibulectomy your surgeon may use bone from your leg (fibula) to rebuild your jaw. When using a fibula free flap they will also remove an artery, vein and soft tissue along with the bone.

The donor site may also need a skin graft. This is done by taking the top layer of skin from another part of your body and moving it to the donor site that needs to be covered. The skin graft is often taken from the buttock or thigh, but your surgeon will discuss these details prior to your surgery.

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What Happens During Surgery?

Both your head and neck surgeons and plastic surgery team will be present during surgery.

First the head and neck surgeons will remove the tumour from your jaw. They will also remove the surrounding soft tissue. The surgeon will then send the tumour to pathology for testing.

At this time your plastic surgeon will also remove the skin, bone and tissue from your donor site. This could take up to four hours.

Once the head and neck surgeon has finished, reconstruction can begin. This involves transferring the tissue from your donor site, matching it as closely as possible. Using a microscope our surgeon will attach the artery and vein from the donor site to an artery and vein in your head and neck area.

The jaw will be set with plates and screws, covered with soft tissue and connected with stitches. This reconstructive procedure can take from six to eight hours.

Recovery and Rehabilitation

Like all types of surgery, a mandibulectomy does have side effects, but these differ depending on the individual.

Common side effects after a mandibulectomy may include:

Nausea – Caused by the general anaesthetic. This will decrease after the operation, but can be treated with medication.
Pain – You will be prescribed pain medication during the operation and during recovery. Please speak with your cancer team if the pain doesn’t subside or gets worse.
Altered eating habits and speaking – This procedure will affect how you speak, chew and swallow. You may need breathing and feeding tubes after surgery, depending on the extent of the operation. You can have a pen and paper or a device to help you communicate, and you will be referred to a speech therapist and/or dietitian during your recovery.
Change in appearance – A mandibulectomy will affect your appearance. You may need to be referred to a psychologist to help you navigate appearance and social issues.
Nerve damage – After surgery you may experience numbness around the lip, chin or jaw areas. It can persist for several months or could become permanent as other nerves are removed with your tumour that affect swallowing, your speech and feeling in your tongue.
Problems wearing a denture – After a mandibulectomy you may find it difficult to wear your denture. You will be referred to a specialist dentist (prosthodontist) to discuss what options are available to you after surgery.

You may not experience all of the side effects. Speak with your doctor if you have any questions or concerns about treatment side effects. Speaking with support groups or other patients who have undergone this treatment may also be helpful.

More information

What else you should know

How long will I stay in the hospital?

Generally, most people will stay in hospital for between 10 and 14 days. The length of your stay will depend on the extent of the surgery and your recovery.

How do I care for my donor site?

For the first two days after surgery you will be required to stay in bed to allow your leg to heal. After this you can sit in a chair, with your leg raised.

For the first three weeks we recommend you keep your leg raised as much as possible as it will help promote healing and help with the swelling.

Speak with your doctor to discuss when you can walk again. At first you may require a walker.

Your nurse will provide post-operative care instructions when you are due to return home.

What symptoms should I watch out for after leaving the hospital?

If you experience these symptoms, contact your surgeon, doctor or medical team as soon as possible.

Swelling – Mild swelling is normal, however if you experience severe swelling accompanied by pain you may have an infection.
Wound discharge – If you wound becomes red, hot and oozes discharge.
Bleeding – Bleeding from the site of your surgery.
Fever- Fever or high temperatures.

How will RPS manage my post-operative care?

Your RPS surgeon will give you specific advice regarding your individual post-operative recovery. They will advise: