Mandibulectomy in Delhi, India

Mandibulectomy is a surgical procedure in which a surgeon removes part or all of the lower jawbone (mandible), usually to eliminate disease that has directly invaded the bone. The procedure is most commonly performed in patients with oral cancers that have spread to the jaw, but it may also be required in cases of chronic osteomyelitis, osteoradionecrosis, or large benign tumours that compromise the jaw’s structure.

The surgery is done under general anaesthesia and involves making an incision inside the mouth or through the skin, depending on the extent of the disease. Once the affected bone is removed, reconstructive surgery may be performed in the same sitting using tissue, bone grafts, or flaps from other parts of the body to restore the jaw’s function and appearance. The procedure typically requires hospitalisation and is followed by close monitoring, nutritional support, and rehabilitation.

Mandibulectomy procedures are classified based on the amount of bone removed and the impact on the jaw’s structural continuity. The choice of type depends on how extensively the disease has involved the mandible, along with the patient’s overall condition and surgical goals. The main mandibulectomy types include:

1. Marginal Mandibulectomy

In this type, only a portion of the mandible’s height is removed, usually the upper border of the bone, without disrupting its overall continuity. It is generally performed when the disease is close to the bone or involves only the surface layer, and deeper invasion is not seen on imaging or during surgery. Since the jaw remains structurally intact, reconstruction may not be required.

2. Segmental Mandibulectomy

This procedure involves the removal of a full-thickness segment of the mandible, leading to a break in the continuity of the bone. It is typically performed when cancer or another disease has deeply invaded the bone. Segmental mandibulectomy can significantly affect the ability to chew, speak, or maintain facial symmetry, so reconstruction is almost always needed.

3. Hemicortical (or Partial Thickness) Mandibulectomy

Only one layer or surface (either the outer or inner side) of the jawbone is removed, preserving the rest of the bone’s structure. This is considered when disease involvement is limited and does not extend throughout the full thickness of the mandible. It offers a more conservative option and may not require extensive reconstruction.

4. Total Mandibulectomy

In very advanced cases where disease involves the entire mandible, a total mandibulectomy may be performed. This involves removing the full length of the lower jaw. It is rarely needed and is typically reserved for severe, extensive tumours or non-healing osteonecrosis. Reconstruction in such cases is complex and usually involves microvascular free flap surgery to recreate the jaw structure.

Note: Each of these procedures may be combined with reconstructive techniques tailored to the patient’s functional needs, facial structure, and long-term recovery goals. The final surgical plan is determined after a thorough review of imaging studies, biopsy results, and multidisciplinary team discussions.

Mandibulectomy is recommended when a condition directly affects the lower jawbone and cannot be managed with conservative treatment. At Max Hospitals, the procedure is part of a comprehensive treatment approach designed to control disease, relieve symptoms, and restore function. Common conditions include:

Oral Cavity Cancers

Mandibulectomy is most frequently performed for oral cancers, particularly squamous cell carcinoma involving the gums, floor of the mouth, or inner cheek. These cancers can invade the mandible, making surgical removal of the affected bone necessary to achieve clear margins and reduce the risk of recurrence. Surgery may be combined with reconstruction and follow-up therapies such as radiation or chemotherapy.

Locally Advanced Head and Neck Cancers

Tumours originating in nearby areas, such as the base of the tongue, buccal mucosa, or salivary glands, may extend into the mandible. In such cases, mandibulectomy may be required as part of a wider surgical plan to remove all involved tissues and prevent further spread. This approach helps ensure complete tumour clearance when bone invasion is confirmed on imaging or during surgery.

Osteoradionecrosis of the Jaw

This condition occurs when the jawbone loses its blood supply due to previous radiation therapy, commonly given for head and neck cancers. The bone becomes non-viable, leading to chronic pain, exposed bone, infection, and difficulty eating. Mandibulectomy is performed in severe cases to remove the dead bone and reduce the risk of complications such as sepsis or jaw fracture. Reconstruction is often necessary to restore structure and function.

Chronic Osteomyelitis

Osteomyelitis refers to a persistent bacterial infection of the jawbone. In long-standing cases that do not respond to antibiotics or debridement, mandibulectomy may be required to remove the infected bone. This helps prevent the spread of infection and relieves ongoing symptoms like swelling, pus discharge, and jaw pain.

Aggressive Benign Jaw Tumours

Certain non-cancerous tumours, such as ameloblastomas and odontogenic keratocysts, can grow aggressively and damage surrounding bone and tissue. When these tumours recur or are extensive, partial jaw removal may be necessary to achieve complete excision. Early intervention reduces the risk of deformity and functional impairment, and in many cases, reconstruction is performed in the same sitting.

Trauma-Related Bone Loss or Implant Complications

In rare cases, trauma to the face or failed dental or reconstructive implants can lead to jawbone damage that cannot be repaired conservatively. Mandibulectomy may be considered if the bone becomes necrotic, severely misaligned, or infected. The procedure allows removal of damaged bone and provides a foundation for later reconstruction.

Before undergoing mandibulectomy at Max Hospitals, patients go through a step-by-step evaluation process to confirm the diagnosis, plan the surgery, and prepare for recovery. The process typically includes:

• Clinical assessment by the head and neck surgeon: A detailed review of symptoms, medical history, and previous treatments is carried out to understand the extent of jaw involvement and determine the need for surgery.
• Imaging studies (CT, MRI, or PET-CT): These scans help map the location and depth of disease, detect any spread to surrounding structures, and guide the surgical approach and reconstruction plan.
• Biopsy for diagnosis (if not already done): A tissue sample may be taken from the lesion or jaw to confirm malignancy or determine the type of disease affecting the bone.
• Multidisciplinary team consultation: A team including surgical oncologists, radiologists, dental specialists, anaesthetists, and reconstructive surgeons evaluates the case to create an individualised treatment plan.
• Dental evaluation: An oral surgeon examines the condition of the teeth and jawbone. Teeth near the surgical site may need to be removed before surgery, and future dental rehabilitation is planned accordingly.
• Nutritional assessment: Patients who have lost weight or have eating difficulties are evaluated by a dietitian. Nutritional supplements may be advised to support healing and improve surgical outcomes.
• Pre-anaesthesia and medical clearance: Blood tests, ECG, chest X-ray, and other investigations are performed to assess surgical fitness. Any existing health conditions such as diabetes or hypertension are managed and stabilised.
• Detailed counselling and informed consent: The surgical team explains the procedure, expected outcomes, possible complications, and the role of reconstruction and rehabilitation. Patients and families are encouraged to ask questions and raise concerns.
• Admission instructions and preparation: Clear guidance is given about hospital admission (usually a day before surgery), fasting requirements, and medication adjustments to be made before the procedure.

A mandibulectomy is a major surgery that requires careful planning and execution. At Max Hospitals, the procedure is carried out by a specialised team of head and neck surgeons, reconstructive experts, and anaesthesiologists working together in a controlled surgical environment. The key steps include:

• Anaesthesia Administration: The procedure begins with general anaesthesia to ensure the patient is fully unconscious and does not feel pain during surgery. Monitoring equipment is connected to track vital signs throughout.
• Incision Placement: Depending on the location and size of the tumour or affected bone, the surgeon makes an incision either inside the mouth (intraoral approach) or on the outside of the face or neck (extraoral approach). In some cases, both may be used for better access.
• Exposure of Jawbone:  Soft tissues including muscles, nerves, and blood vessels are carefully retracted to expose the mandible. Care is taken to protect surrounding structures, particularly the facial nerve and major vessels.
• Bone Resection:  The affected part of the jawbone is precisely removed using surgical saws or drills. The extent of removal (segmental, marginal, or total mandibulectomy) depends on how far the tumour or damage has spread. Bone margins are often sent for intraoperative analysis to ensure complete excision.
• Lymph Node Dissection (if needed): If cancer has spread, nearby lymph nodes in the neck may also be removed as part of the same surgery to prevent further spread of disease.
• Reconstruction of the Jaw: In most cases, reconstruction is done immediately after resection. This may involve using a bone graft (often from the fibula, scapula, or iliac crest) to recreate the jawbone. Titanium plates or custom implants may also be used to provide structural support and restore facial symmetry.
• Soft Tissue Reconstruction: Local flaps or free tissue transfer (such as a radial forearm or anterolateral thigh flap) may be used to cover exposed areas, especially when both bone and soft tissue are removed.
• Placement of Drains: Surgical drains are inserted to remove excess fluids and prevent infection. These are typically removed a few days after surgery once drainage reduces.
• Wound Closure: The incision is closed using sutures or staples. Care is taken to align tissues properly for optimal healing and appearance.
• Transfer to Recovery Room:  After surgery, the patient is moved to the recovery room and closely monitored until they wake from anaesthesia. Vital signs, airway stability, and pain levels are assessed before transfer to a hospital room or ICU, based on the case.

Recovery after a mandibulectomy is gradual and depends on the extent of jaw removal and the type of reconstruction performed. At Max Hospitals, care continues after surgery with a focus on healing, rehabilitation, and emotional support. Here's what patients and families can expect in the post-operative phase:

• Hospital Stay: Most patients remain in the hospital for about 7 to 10 days. If the surgery was extensive or involved reconstruction using tissue from another part of the body (such as the fibula), an initial stay in the ICU may be needed for close monitoring of vital signs and flap health.
• Pain Management: Pain is managed using intravenous or oral medications. The surgical team adjusts dosages based on patient comfort and recovery progress. Nerve pain or stiffness in the jaw or neck area may also be addressed through medication.
• Monitoring of Reconstruction (If Done): If the mandibulectomy involves free flap reconstruction, doctors and nurses will monitor blood flow to the flap closely for the first few days. This includes checking colour, temperature, and capillary refill to ensure the transplanted tissue remains healthy.
• Wound and Drain Care: Surgical drains placed during the operation help remove excess fluid from the site. These are usually removed within a few days. The incision site will be regularly cleaned and dressed to prevent infection. Antibiotics may be prescribed as a precaution.
• Nutritional Support: Patients are usually kept on tube feeding initially, especially if the surgery has affected their ability to chew or swallow. Feeding is done through a nasogastric tube or gastrostomy tube depending on the case. Dietitians work closely to maintain proper nutrition and guide transition to oral intake once safe.
• Speech and Swallowing Rehabilitation: A speech-language pathologist evaluates the patient's ability to speak and swallow post-surgery. Therapy sessions begin in the hospital to restore clear speech, safe swallowing, and effective communication. This continues on an outpatient basis as needed.
• Jaw and Neck Mobility Exercises: Physiotherapy is often recommended to improve range of motion in the jaw, neck, and shoulder, especially if neck dissection was done. These exercises help reduce stiffness and maintain muscle strength.
• Tracheostomy Care (If Done): If a temporary tracheostomy was performed during surgery to assist breathing, hospital staff will teach the patient and caregivers how to care for it. In most cases, it is removed before discharge.
• Emotional Support: Changes in facial appearance, speech, or eating ability can impact confidence and emotional well-being. Max Hospitals provides access to psychologists and support groups for patients and families during recovery.
• Follow-Up Appointments: Patients are scheduled for regular reviews with the surgical team. These visits focus on wound healing, recovery of speech and eating, and detecting any signs of complications or cancer recurrence. Additional treatment such as radiation or chemotherapy may be discussed based on final pathology.
• Long-Term Rehabilitation: Some patients may require further reconstructive procedures, dental implants, or maxillofacial prostheses. These are planned as part of long-term care. Ongoing therapy for speech and swallowing may also continue based on progress.

Mandibulectomy is a major surgical procedure, and like any operation, it carries certain risks. The nature and severity of complications can vary based on the extent of jaw removal, the patient’s overall health, and whether reconstructive surgery is performed. At Max Hospitals, efforts are taken to minimise these risks, but it is important to be aware of possible complications:

• Infection: Surgical incisions and reconstructed areas are at risk of infection, especially in the oral cavity where bacteria are naturally present. Infections may develop shortly after surgery or during the healing phase. Preventive antibiotics are given, and wounds are monitored closely for signs such as swelling, redness, or pus formation.
• Bleeding and Haematoma: As the jaw and surrounding areas contain many blood vessels, bleeding can occur during or after surgery. In some cases, internal bleeding may lead to a collection of blood (haematoma), which may require drainage. The surgical team uses advanced cauterisation and haemostatic methods to control bleeding during the procedure.
• Nerve Injury: The mandibular nerve and other branches of the facial nerve may be affected, leading to numbness, tingling, loss of sensation, or muscle weakness in areas like the lower lip, chin, or tongue. Some nerve injuries may improve with time, but others can be permanent. Nerve-sparing techniques are used when feasible.
• Changes in Speech and Swallowing: Removal of the jawbone can impact tongue mobility and oral cavity structure, making it difficult to pronounce certain words or swallow solid foods. This may improve with rehabilitation, but some patients require prolonged speech and swallowing therapy depending on the extent of the surgery.
• Chewing and Eating Difficulties: After a mandibulectomy, patients often experience difficulty chewing food, especially if teeth have been removed or if jaw reconstruction is delayed. Dietary modifications are often needed in the early stages, and prosthetic or reconstructive options may be considered later to restore function.
• Facial Asymmetry and Scarring: A visible change in facial shape may occur after removal of the jawbone, especially if a large segment is taken out. Surgical incisions may also leave scars on the face or neck. Reconstructive surgery aims to restore symmetry, and cosmetic techniques are sometimes used to reduce scarring.
• Delayed Wound Healing or Flap Failure (in Reconstructed Cases): When free tissue flaps or bone grafts are used for reconstruction, there is a risk of the flap not integrating well due to poor blood supply, smoking, diabetes, or other factors. This may lead to tissue necrosis or delayed healing, requiring revision surgery or prolonged wound care
• Tracheostomy-related Complications: Some patients may need a temporary tracheostomy to help them breathe during the recovery period. This can occasionally lead to infection, bleeding around the tube, or granulation tissue formation, which must be carefully managed during follow-up.
• Tumour Recurrence (in Cancer Cases): Even after complete removal of the visible tumour, microscopic cells can remain. Regular surveillance through imaging, endoscopy, or biopsy is needed, and additional treatment such as radiation or chemotherapy may be planned if recurrence is detected.
• Emotional and Psychological Distress: Undergoing surgery that changes appearance or basic functions such as speaking and eating can affect emotional well-being. Patients may experience anxiety, depression, or social withdrawal. Psychological support, peer counselling, and reconstructive options are made available at Max Hospitals to help patients cope.

Will I need a feeding tube after a mandibulectomy?

In some cases, especially if swallowing is difficult after surgery, a temporary feeding tube may be used to provide nutrition. This is usually placed through the nose or directly into the stomach and helps support recovery until safe oral intake is possible.

How long will I stay in the hospital after the surgery?

The hospital stay often ranges between one and two weeks. It depends on how extensive the surgery was, whether reconstruction was done, and how well recovery is progressing. Doctors monitor wound healing, pain levels, and nutritional intake before discharge.

Can the jawbone be rebuilt later if it’s removed during surgery?

Yes, reconstruction of the jawbone is possible using bone grafts from other parts of the body like the fibula or hip, or with titanium implants. Sometimes reconstruction is done during the same procedure, or it may be planned for a later stage.

Will I be able to speak normally after surgery?

Speech may be affected temporarily, especially if the surgery involves the tongue or surrounding tissues. Most patients see improvement with speech therapy. The degree of recovery depends on how much tissue was removed and how successful the reconstruction is.

Are there any long-term restrictions after a mandibulectomy?

Chewing, swallowing, or speaking may take time to improve. Heavy physical activities are usually restricted in the early recovery period. Many patients are able to return to regular routines with support from rehabilitation services.

Will I need additional cancer treatments after the surgery?

If the surgery was done for cancer, further treatment such as radiation therapy or chemotherapy may be recommended. This depends on the tumour type, size, and whether the cancer had spread to nearby lymph nodes or tissues.

How soon can I return to work or normal life?

Recovery varies from person to person. Light activities may resume in a few weeks, but returning to work depends on the individual’s progress, type of job, and the presence of any physical or speech challenges after surgery.

How visible will the scars be?

The appearance of scars depends on where the incisions were made. Some cuts are hidden inside the mouth, while others on the neck or face may leave visible marks. These often fade with time, and cosmetic procedures may help in improving their appearance.

What should I bring with me to the hospital for this surgery?

It’s helpful to bring loose-fitting clothes, personal hygiene items, all current medications, medical records, and any items that provide comfort such as soft pillows or earplugs. Hospital staff usually share a checklist during pre-surgery appointments.

Is it possible to get a second opinion before the surgery?

Yes, many patients find it reassuring to consult another specialist before undergoing a major surgery. Max Hospitals offers second opinion services for patients who want to review their diagnosis and treatment plan.

Reviewed by Dr. Rohit Nayar, Principal Consultant – Plastic, Reconstructive and Aesthetic Surgery, on 09 December 2025.