Jaw tumors refer to growths within the upper and lower jaw bones, which can be either benign or cancerous. These tumors often lead to significant discomfort, affecting functions such as eating, speaking, and swallowing.
Jaw tumors encompass various types, including Ameloblastoma, Aneurysmal bone cysts, and Giant cell tumors. Additionally, cancers like osteosarcoma, chondrosarcoma, and Ewing’s sarcoma can affect the jaws.
Common symptoms of jaw tumors include:
Surgical excision of a jaw tumor with the removal of a segment of the jaw can cause serious issues in the management of air passages of the person’s face. Other problems faced by the individual include difficulty in chewing, speech, and cosmesis.
After the removal of the jaw, it becomes imperative to restore the continuity of bone. Jaw reconstruction will also enable its functioning to allow a person to eat, swallow, and speak as before while giving the surgical site a more cosmetic appearance.
Jaw reconstruction is most commonly performed with the help of microvascular transfer of bone and soft tissue taken from the leg and fixed with reconstruction plates and screws. It is a highly specialized microvascular surgery procedure consisting of the harvest of a bone flap, shaping and fixation of bone, insetting of skin and soft tissues, microvascular anastomoses, and external skin closure.
Once the jaw is fixed with the bone flap, artificial teeth can be implanted into the bone after one year of the surgery. This will enable the patient to chew food from that side of the jaw and improve the cosmesis of their face and smile.
Jaw Reconstruction can be done at the time of jaw removal surgery or after a few months or years as a separate surgery.
Primary Reconstruction- This is performed at the time of the surgical excision of the tumor.
Secondary Reconstruction- This is performed as a separate procedure after the tumor removal.
Primary Reconstruction is the best treatment as it restores the structure and function rapidly, reducing the number of operations and the overall duration of stay in the hospital.
Jaw Reconstruction aims to restore the continuity of the mandible/maxilla, the height of bone-bearing teeth, reconstruct lower facial contours if the lower jaw is removed or midfacial contours if the upper jaw is removed, preserve the Temporomandibular Joint, and restore adjacent soft tissue defects.
During the consultation, Dr. Amit Agarwal focuses on:
Surgical excision of the tumor with the removal of the segment of the jaw, along with the reconstruction of the jaw, is done in the same sitting.
It can be either lower jaw (mandible) or upper jaw (maxilla) excision depending on the location of the tumor.
A. Lower Jaw (Mandibular) Excision/Mandibulectomy: It is the surgical removal of all or part of the lower jawbone. It can be of 3 types:
B. Upper Jaw (Maxilla) Excision/Maxillectomy: It is the surgical removal of all or part of the upper jawbone. It can be of 3 types:
Initially, general anesthesia is administered by a very competent anesthetist and intensivist. A tracheostomy is done if required. A Ryles’s nasogastric tube is inserted through the nose, and a urinary catheter is placed for draining urine and monitoring. Jaw resection is done through an appropriate incision.
Reconstruction of both the lower and upper jaw is challenging, but reconstruction of the upper jaw is more difficult.
The fibula bone, which is the smaller one of the two bones present in the leg, can be used to reconstruct both the lower and upper jaw. The bone is harvested with its artery, vein, and skin. The flap is then transferred to the head and neck region. The bone is reshaped and is fixed with the remaining jawbone with plates. Skin and soft tissues taken with the bone are inset in the defect created after the excision, and the vessels are anastomosed at the recipient site with an appropriate artery and vein.
The donor site is covered with the help of a skin graft taken from the thigh.
Removing part of the fibula bone from the leg does not create any problem in walking or movements of the leg and foot.
This surgery needs surgical expertise and a good working team. Dr. Amit Agarwal specializes in microsurgical reconstruction and has reconstructed innumerable jaws with free fibula bone.
The success rate of free fibula reconstruction is quite good, around 95% in the hands of Dr. Amit Agarwal. It means 95 out of 100 jaws are successfully reconstructed. The results of microsurgical reconstruction can be quite unpredictable as they depend on multiple factors like the status of blood vessels, the level of immunity of the patient, their health status, and protein levels to withstand the procedure.
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