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Maxillectomy: Oral Cavity Cancer



What Is It?


The oral cavity includes the mouth and the throat at the back part of the mouth, often called the oropharynx. The oral cavity typically includes the lips and lining of the cheeks, the salivary glands, the hard palate or roof of the mouth, the uvula and soft palate which constitute the back of the mouth, the floor of the mouth or section under the tongue, the tongue and tonsils.


Cancer can begin in any one of these areas in the cells of these areas and spread throughout other organs of the body. Oral cancer often starts in the tongue or floor of the mouth, and typically starts in flat cells known as squamous cells that cover the mouth, tongue and/or the lips. When it does spread it usually does so through the lymphatic cells. Cancer that spreads to other areas of the body is still oral cancer and may require surgery to correct. A dentist often diagnosis oral cavity cancer during a routine exam.


Some symptoms of oral cavity cancer may include bleeding gums, loose teeth, an earache, a lump in the neck, red or white patches in the oral cavity, a sore on the lip or in the mouth that does not heal difficulty and pain when swallowing.




The Operation


A maxillectomy is a surgical procedure used to treat oral cavity cancer and cancers affecting the jaw and sinus cavity. The procedure may create a connection between the nose, sinus and oral cavities which can make speech and swallowing challenging. Often patients may require artificial maxillary obturator prosthesis to help them recover from surgery and speak and swallow well following surgery.


There are three types of dental treatment which may be helpful to patients undergoing a maxillectomy. One prosthesis can be used during surgery, which is implanted to help restore the ability to speak and swallow immediately following surgery. The patient is able to in these cases immediately start a soft diet following surgery. Shortly after surgery this device is removed and replaced by what doctors call an “interim obturator prosthesis” which helps replace missing teeth and which the patient can remove to clean the surgical site and the device.




Alternatives to Surgery


If the oral cancer is progressive, surgery is the best option to consider. Generally the dentist and oral surgeon will employ other methods before suggesting this surgery.




Before The Operation


Your doctor will perform a comprehensive exam and perform a biopsy where he or she removes some tissue to examine cells for cancer. A biopsy may be performed with just local anesthesia although sometimes general anesthesia is required. Usually a specialist known as a pathologist reviews the sample and looks for cancer.


A biopsy can reveal what stage the oral cancer is at, or how extensive the cancer is, which can reveal how necessary surgery is and what other types of treatment may be necessary.




After The Operation


Typically a patient will wear an interim oburator prosthesis for between three to six months following surgery to allow the surgical incision to heal. During this time the patient will need their prosthesis adjusted, so a patient can expect to see a dental oncologist every month during rehabilitation. Following a complete recovery a patient can acquire a permanent obturator or prosthesis which will allow for near-full swallowing and speech ability. Most patients will regain normal or near normal functioning with this device.


Some patients will still require additional treatments including irradiation and in some cases chemotherapy depending on the stage of their oral cavity cancer.




Possible Complications


Patients that have periodontal disease or other infections in the mouth can develop a condition following surgery and radiation known as osteoradionecrosis which can be debilitating. Further patients can develop serious infections following surgery. Some patients will exhibit speech and swallowing difficulties for several months following their procedure and rehabilitation will be needed to help restore full functioning.


Rehabilitation is also necessary to maintain or achieve full oral opening following surgery. Some patients will need to have teeth removed or extracted to prevent further infection especially if the teeth are not in god shape.




General Advice


Good oral hygiene practices are critical following a maxillectomy and any other dental procedure to help reduce the risk of infection which can be life threatening. Patients that have difficulty keeping their teeth clean should visit their dentist regularly. Oral cavity cancer is a life-threatening condition that can be difficult to treat and diagnose. It is important at the very minimum that you see your dentist annually for a routine check up. This will help prevent disease like oral cavity cancer from wreaking havoc on your life.




Estimated Costs for Oral Cavity Cancer Surgery


The cost of oral cavity cancer surgery or maxillectomy varies from country to country. Some countries include the cost of your recovery stay into the cost of surgery. In addition to the cost of surgery many patients will have to pay for irradiation and chemotherapy. Some patients will also have to pay additional hospital fees for follow up visits. If patients experience a relapse their fees will be higher. If the cancer is in a mid to late stage then patients may have even more fees to pay depending on how aggressively they want to treat their disease. Some patients may also want to use a combination of natural and traditional medical healers to approach their illness. The costs provided may or may not include the costs associated with prolonged hospital stays in each country.


Country Costs
USA $13,000-$22,000
Malaysia $7,000-$12,000
Singapore $8,000-$12,000
India $4,500-$8,000
Thailand $7,000-$9,000

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