Maxillectomy in Dogs
Dr. Nicholas Trout
Maxillectomy is a surgical procedure in which a portion of the upper jaw is removed. This can involve both sides of the face or just one side. Up to one half of the upper jaw can be removed.
Maxillectomy is most commonly undertaken for the treatment of benign or malignant tumors affecting the upper jaw. Occasionally, maxillectomy may be selected as the best option for animals with certain types of jaw fracture, jaw bone infection, or fractures that have failed to heal properly.
Most animals with oral tumors are older, and certain breeds of dog are more commonly affected by certain types of tumor. For example, dogs with black pigment in their mouths have a higher incidence of malignant melanoma.
Osteomyelitis (infection and inflammation in the bone) in the jaw most commonly occurs secondary to dental disease, and is more frequently seen in small and toy breeds of dog.
What to Expect
Maxillectomy may be discussed as a potential treatment option for an oral mass. Your pet may receive a biopsy to confirm the mass to be a tumor and then this area may be radiographed or imaged using a CT scan, to assess the likelihood of complete surgical excision.
Your vet may show you pictures of dogs or cats that have undergone maxillectomy. In dogs in particular, the maxilla tends to define the shape of the face. As a result, removal of portions of the upper jaw usually result in a significant alteration in your pet's appearance.
Dogs have plenty of loose skin around their mouth to allow reconstruction of the defect produced when part of the maxilla is removed. It is important to remember that animals are not concerned with their own cosmetic appearance. They do not look in mirrors to assess their own beauty. Their primary concern is to be free of pain or discomfort and to be able to eat, drink and breathe normally.
The bone is removed using a saw, a drill, a wire or a bone chisel (osteotome). Teeth are usually removed with the bone. Local nerves supplying the jaw can be blocked with local anesthetics. Pain is carefully prevented and controlled by the judicious use of morphine derivative compounds. These medications can ensure that your pet is comfortable throughout the procedure and during the recovery phase.
Your animal will be hospitalized until he is comfortable and beginning to eat and drink. Some animals may need nutritional support in the form of a feeding tube into the stomach since their desire to eat and drink may take longer. This type of feeding will ensure adequate nutrition as the surgical site heals.
What You Can Do
Be prepared to experiment with soft foods, boiled chicken, boiled ground beef, hot dogs etc. in order to get your pet eating again. Hand feeding and watering can be essential in the early recovery.
Following maxillectomy, the skin overlying the surgical site may tend to "blow out" and "suck in" during normal breathing. This is because many maxillectomies will break into the nasal cavity. This will resolve over the first week or so following surgery and is not a cause for alarm.
Depending on the exact nature of the procedure, a tooth or teeth may protrude from the lower jaw up toward the surgical site. In most cases this will have been assessed at the time of the surgery to make sure it does not interfere with normal eating or the healing process. If a lower canine tooth, for example, does appear to be pinching on the maxillectomy site, call your veterinarian.
Lack of available tissue to close the surgical site is more of a problem for the upper jaw than the lower jaw, and more of a problem the further you go back in the mouth. The possibility of wound breakdown is higher for surgery on the upper jaw than lower jaw.
Surgical site breakdown for a maxillectomy can result in a communication between the mouth and nose, referred to as an oro-nasal fistula. This can allow food and water to get into the nasal cavity. Depending on its size and location, an oro-nasal fistula may or may not need to be fixed by a further surgical procedure.
If there is a surgical incision through the skin it should be checked daily for swelling, redness or discharge. Skin sutures will need to be removed in 10 to 14 days following the procedure.
It is usually best not to stretch the mouth open to inspect oral sutures. Just note your pet's water when drinking for signs of bleeding into the water.
Despite the mouth being a "dirty," bacteria-laden site, infection is not common following maxillectomy because it has such a great blood supply. In most cases, antibiotics will be given at the time of surgery and not be required after that time.
Preventing a maxillectomy may not be feasible for certain types of oral tumor. However, daily dental care and regular inspection of the mouth will help you notice abnormal lumps or bumps when they are smaller and more easily removed, and also help control dental disease which may predispose bone to infection and fracture.