Hemimandibulectomy

By

Dr. T. Balasubramanian M.S. D.L.O.




Definition:  Hemimandibulectomy is a procedure whereby one half of the mandible is removed surgically.  


Indication:

Hemimandibulectomy is indicated in the following conditions:

1. Carcinoma cheek with extension to the mandible
2. Osteoradionecrosis following irradiation of the mandible
3. Malignant tumors of mandible (i.e. osteosarcoma)

Procedure:

This surgical procedure is performed under general anesthesia. 

Incision:  The lower lip is split, and a vertical incision is made up to the level of chin.  The incision is then turned horizontally about 1/2 inch below the lower border of the mandible.  The horizontal arm of the incision is extended up to the level of the angle of mandible.  At the level of the angle of the mandible the incision is turned upwards vertically and extended up to the level of the mastoid tip.











Fig showing the incision



The incision is deepened, mandible is exposed.  Close to the mental foramen, there may be bleeding because of the presence of neurovascular bundle.  Vessels coming out of the mental foramen are cauterised.  The lower incisor is removed.  The inner surface of the mandible is slowly exposed by dissecting the oral mucosa.  Using a gigli saw a vertical cut is made in the mandible up to the level of mentum.  This vertically splits the mandible.  The mandible is freed anterirorly  from the muscles attached  i.e.

Depressor labii inferioris
Depressor anguli oris
Platysma

The mandible which is to be resected is freed from the attachments to the oral mucosa, gently.  At this stage the oral component of the tumor is addressed.  The mass is mobilised and excised with adequate tumor margins.  The medial surface of the mandible is freed from the attachements of masseter muscle. 

The second osteotomy is made just below the level of condylar process.  The whole of the mandible is freed and removed.

The inner mucosal lining is reconstructed using either the buccal mucosal flap or a tongue flap.


Complications of mandibulectomy:

1. Bleeding
2. Cosmetic defects i.e. andy gump deformity
3. Inability to chew food

Reconstruction:

After excising one half of the mandible the defect can be reconstructed using iliac crest bone graft.

 

 

 

 

 
























 






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