To begin the mandibulectomy, make four initial cuts. The first two are in the gingiva—one on the rostral aspect of the most
rostral tooth to be excised and one on the caudal aspect of the most caudal tooth to be excised. Next, make one incision in
the buccal mucosa to connect these rostral and caudal cuts and one in the lingual mucosa to do the same.
Use a Freer periosteal elevator to boost the gingiva from the mandible along these incised areas and delineate the margins
Next, use an oscillating saw or osteotome and mallet to cut the bone. You may also use a Gigli wire saw, although it's more
difficult to handle because of the traction needed and because it can easily lift the patient's head off the surgical table.
It's helpful to have bone wax on hand to plug the mandibular canal, as bleeding from the mandibular alveolar artery and vein
can be profuse.
Try to cut both ends of bone as quickly as possible so the entire piece of mandible can be removed, providing the best exposure
for hemostasis. Smooth or taper the cut edges of the mandible using a pair of rongeurs to reduce tension during closure. Submit
the removed portion of mandible for histopathologic examination, with the cut edges marked as rostral or caudal to allow for
To close a hemimandibulectomy, undermine the cut buccal mucosal edge to create a mucosal flap, which is then sutured to the
lingual mucosa and gingival edges. Although closure may be possible without creating a flap, a tension-free closure is paramount
in oral surgery. Additionally, undermining this tissue will prevent or minimize the unsightly "dimple" that can occur when
the skin is pulled medially with the mucosa and submucosa during closure.
First, close the submucosa with 3-0 or 4-0 absorbable sutures. You can achieve mucosal-to-mucosal apposition by using a simple
continuous pattern with 4-0 to 5-0 absorbable sutures. Whether monofilament or multifilament suture is used, intraoral absorbable
sutures do not need to be removed, as they will break down and be swallowed by the patient. If a rostral mandibulectomy has
been performed, a V-shaped wedge of full-thickness tissue will often need to be removed from the chin to prevent the dog from
having a "pouty" lip, which could cause excessive drooling and dropping of water.
Closure is in three or four layers, from the inside out: mucosa, submucosa, connective tissue and muscle (the submucosa and
connective tissue and muscle may be closed as one layer where appropriate) and skin (Figure 2). If a commissurotomy has been
performed, close it in the same manner.
Figure 2: Closure to recreate the chin.
Postoperatively, continue injectable opioid pain medications for 12 to 24 hours, followed by oral pain medications including
a nonsteroidal anti-inflammatory, if not contraindicated. Offer patients water and a small meal of canned food in meatball
form the day after surgery (Figure 3). Soft food should be fed for two weeks postoperatively to minimize trauma to the mucosal
suture line. An Elizabethan collar should be sent home with patients having a skin incision (e.g., commissurotomy) to prevent
scratching at the site and grooming by housemates.
Figure 3: Postoperatively, the patient was able to fully retract the tongue into the mouth and learned how to prehend food
within the first 48 hours.
Recheck patients at 10 to 14 days to evaluate the surgical site, particularly the intraoral component.
Dr. Nicki Green is a board-certified veterinary surgeon currently performing relief work for various universities and privately owned practices.
In her spare time, she enjoys running, drawing and spending time with her husband, dog and two cats.