Dental reconstruction after mandibulectomy?

Hi Eliza, I had a partial mandibulectomy as well in July last year. They removed a couple of teeth on the lower jaw where they were replacing it with the fibula. At the time a restorative dentist came in at the end of the surgery and put a couple of posts in - one in that area and one more for a tooth that had been removed years before. I also had radiotherapy in October and November but in January I went back to have the tooth planned for. They added the tooth to the old area BUT the other post unfortunately had come loose from the new jaw bone as the new bone had receded. No biggy for me to be honest as I am chewing on the side where I didn’t have surgery. They did say though that it would not be viable to do anything else in the new part of my jaw. Not sure if that helps but in my case they are very reticent about doing anything more in the area of the surgery. How is your overall recovery going, if you didn’t have any radiotherapy it might be a different scenario 

Hi Eliza. I had a right mandibulectomy in 2013 but it was only partial as I did not need a reconstruction. Consequently I have a very thin bit of bone left in my right mandible. There is not enough bone for implants so I went down the path of a denture. However it was so uncomfortable that in the end I gave up on it and am now happily gappy. At that stage it did not affect my eating as I could chew on the left side of my mouth. Since then I have had 2 maxillectomies and now have an upper denture. I am now unable to chew as a result so am on a pureed diet. I realise how difficult it is not to have enough teeth to help with chewing which is maybe be where you are at the moment. 

It is a difficult decision trying to decide about further surgery. Would implants help with your eating? Are you happy with the aesthetics of not having lower teeth on one side? Could you try a denture first to see if that would work? You might have more success than I did with mine. Sorry I'm not much help but I have never regretted not having teeth in my right lower jaw as for me the options were limited so implants not an option. I hope someone else on the forum has had implants in their lower jaw and can give you some info on their experience.

Best wishes

Lyn

Thank you so much for replying Gsterc7a3c6. I'm doing OK recovering slowly but surely. Still have pain in my face, mouth and jaw joint as well as my left leg but meds mostly helping. I didn't have radiotherapy. My consultant together with my reconstruction dentist have discussed surgery as a possibility but it would be complex and there would be no guarantees that it would work.  As I say I'm just weighing up the pros and cons. How is your recovering?

Best wishes

Eliza

Thank you so much for replying Lyn. I asked about dentures but not an option. I can either leave things as they are or have surgery to put in dental implants and remove some scar tissue. I'm not considering surgery for any cosmetic reasons. I'm getting used to my wonky smile! It's really to help with the pain that I'm having. Eating is difficult as I don't have any teeth on my left side and the teeth that I do have don't align properly or not as they once did. Implants might help, however I've been told surgery isn't guaranteed to work. I'm not sure what to decide.

Best wishes

Eliza

Good to hear you are doing well, it’s a long haul so be kind to yourself on the way (something I am trying to learn). I was very blessed with how I was post surgery pain wise once I got home from hospital, I had some paracetamol overnight for a couple of weeks but that was it. I really did recover well. Still have lymphoedema under my chin which is frustrating but is for life and the inside of my mouth still feels horrible. However a lot of that was made worse by the radiotherapy which I didn’t have to have but decided to as the cancer was very aggressive and even though my surgeon got it all out with good margins and there was no spread to my lymph nodes, I decided to go for the belt and braces. I was at my consultant 2 weeks ago and he was very happy with how I’m doing but said it would be another 8 months before I would get to where I would be long term which was a bit frustrating. I’ve got some other niggly things  I am dealing with but really doing very well.

i really can only chew on one side of my mouth and don’t see that changing so for me having my more teeth on the other side wouldn’t make a difference so even if it was possible I probably wouldn’t do it.

it must be a difficult decision for you to weigh up so hope you find a way through and get good advice.

Wonderful to hear your recovery is going so well. The surgery, I'm sure you'll agree was really brutal but we survived it! This surgery wouldnt be nearly so drastic but I don't know if I can face going through more. Still if it alleviates the pain it might be worth it. Then again I'd hate to go through it only for it to fail. Sorry for whinging. I need to get this into perspective. I'm sure I'll make the right choice.

Best wishes

Eliza

Hi there Eliza, I had same surgery as yourself four years ago last week; I was never offered implants, and to be honest I would not have gone down that route - even dentures I am sure I could not tolerate due to the general soreness of the scar tissue.  I did not have radiotherapy, my decision. My diet is obviously a tadge limited (oh for a bacon sandwich!).  I do not have any actual pain in the jaw area, just a dull ache occasionally. Has the Consultant said implants will reduce the pain you have? My face is slightly lobsided but I notice it more than other people. I do hope your pain improves soon, sending you all my very best wishes and if I can be of any help please ask.

June

Thank you June. My diet is also limited mainly a soft diet. I still drink with a straw as I tend to drool without one. My face too is lopsided but like you I think I'm the only one who really notices - other folk notice the scars or lymphoedema (though both improving.) I can happily live with all of the above. The only reason I'm even contemplating more surgery is to get rid of the gnawing ache in my mouth. My consultant said there's no guarantees that surgery will do that. Im seeing him again next month to discuss it further. Thanks again for replying I was so delated with my meeting with him yesterday as I thought surgery would fix everything. Maybe I just need to accept my new normal and be grateful for all that I have.

Best wishes

Eliza

Yes the surgery and recovery from was brutal. I still have quite a lot of internal swelling from where the “flap” was put in that was made worse by the radiotherapy but my consultant thinks it will reduce by about 50% still (though I think he is plucking numbers out the air) - but I am hopeful. The scar has pretty well gone for me and my leg has healed well too even though I still compensate when walking but I’ve had physio to help with that - all in all I am doing well.

Dont apologize for whinging that’s what you need to do sometimes. It’s a hard choice before you - one thing I don’t get is how implants would help the pain you are in.

Has your consultant said if he thinks the pain will subside in time or what might be causing it?

Thank you for your support Gsterc7a3c6. Sometimes you need a wee whinge to let off steam. Consultant isn't 100% sure but has mooted the idea that the pain is tightening of muscles supporting the jaw joint.  My teeth on my right side don't align as they did before surgery so that might cause muscle stress on my left side. Surgery to loosen scar tissue might help but there's no guarantees. I'm seeing him next month to discuss it further before making a decision.

Thanks again & best wishes,

Eliza