Surgical Procedures: Maxillectomy

What is a maxillectomy?

The maxilla is the upper part of the jawbone. Surgery to remove the maxilla is called a maxillectomy.

Maxillectomy can be used to treat cancer of the oral cavity (inside the mouth), nasal cavity (inside the nose), and/or maxillary sinuses (pockets found in the bones of the face).

There are a few different types of maxillectomy:

• Medial maxillectomy: The part of the maxilla next to the nose is removed. This can be done through an incision (surgical cut) on the face or by using tools through the nostril (nose). Reconstructive surgery is not often needed.
• Infrastructure maxillectomy: Removes the hard palate (roof of the mouth), lower part of the maxilla, and teeth. The orbital floor (bone below eye) is not removed. Reconstructive surgery is often needed.
• Suprastructure maxillectomy: The upper part of the maxilla and orbital floor (bone below the eye) is removed. In some cases, the orbit (bone around the eye) may be left in place. Due to the removal of the bone below the eye, reconstructive surgery is needed.
• Subtotal maxillectomy: Removes only part of the maxilla using one of the above procedures.
• Total maxillectomy: Removes the whole maxilla on one side (unilateral), as well as the hard palate and orbital floor (bone below the eye). Reconstructive surgery, possibly with prosthetics, will be needed after this surgery.

Note: Depending on the surgery, chronic tearing of the eyes may be a problem for patients. This happens because there is a blockage in the tubes that drain tears. Your surgeon may place small tubes to allow the tears to drain into the nose. Other surgeries, including skin grafting, the placement of a tracheostomy (tube/hole that allows you to breathe through the neck), and/or feeding tube may also be needed.

With some of these procedures, you may need a prosthetic (artificial) device to fill in the roof of the mouth where the bone was removed. This helps make it possible to eat, speak, and swallow as normally as possible. A prosthetic device may also be used to keep skin grafts in place.

What are the risks of a maxillectomy?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure).
• Bleeding.
• Hematoma (A collection of blood that will go away on its own or may need to be treated with surgery).
• Infection.
• Blood clots, including a pulmonary embolus (blood clot in the lung).
• Enophthalmos (when the eye sinks into the cheek).
• Nerve damage that causes numbness in the cheek.
• Numbness or weakness.
• Epiphora (chronic eye tearing).

Before surgery, your provider will talk to you about any other risks based on your health and the surgery you are having.

What is recovery like?

Recovery from a maxillectomy depends on the procedure you had. Often, a one-to-two-week hospital stay is needed. In some cases, a temporary feeding tube may be needed to give you nutrition during and after the healing process.

You will be told how to care for your incisions and will be given any other instructions before leaving the hospital. Your provider will talk to you about changing your diet, caring for your feeding tube and/or tracheostomy, as well as the need for speech therapy or other rehabilitation.

Your care team will talk with you about the medications you will be taking, like  those for pain, blood clot, infection, and constipation prevention and/or other conditions.

Your provider will talk to you about any changes you will need to make in your activity level, which depends on the surgery you had. This could be:

• Do not do strenuous activity for 2 weeks after surgery or until your surgical team says you can. This includes bending, lifting, and/or straining.
• Change your diet as you are told by your care team. You may need to avoid hot food/liquids. If you have numbness from your surgery, you may not be able to feel how hot a food/liquid is, and it could cause a burn.
• Shower when your care team says you can.
• Brush your teeth as you are told. You should brush your teeth with a soft toothbrush and use saline rinses (irrigations) of the nasal cavity as directed.

What will I need at home?

• A thermometer to check for fever, which can be a sign of infection. Your care team will tell you at what temperature you should call them.
• Wound, feeding tube, and tracheostomy stoma care supplies, if needed.

When should I call my provider?

Your provider will tell you when to call the office. You may need to call the office if you have:

• Changes in how you are breathing.
• Fevers of >101°F/38.3°C.
• Increasing swelling.
• Pain that is not relieved with prescribed pain medication.

If you feel like you are not getting enough air, or if it is getting harder to breathe, call 911 right away.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.