Partial Maxillectomy in Cats

Partial maxillectomy in cats is a surgical procedure involving the removal of a portion of the maxilla, incisive bone, palatine bone, and perhaps portions of the zygomatic and lacrimal bones. The indications for a feline to have a partial maxillectomy include oral tumors, jaw fractures, or an oronasal fistula. Most oral cavity tumors are locally invasive and require a wide excision for optimal local control. That being said, despite the use of other advanced therapy options such as immunotherapy, radiotherapy, or chemotherapy, surgery remains the most effective option. A partial maxillectomy should be performed by veterinary surgeon, preferably one that specializes in oral health and/or cancer. 

A partial maxillectomy in cats will be conducted as follows:

1. The labial and gingival mucosa, plus the lateral space to the mass are excised with a 1cm margin minimum. 
2. The incision is continued through the hard palate, caudal to the lesion/growth. 
3. An oscillating bone saw will be used to perform osteotomies over the previously created mucosal incisions
4. The resection bone is removed 
5. Soft tissue is attached together to cover all exposed fleshy areas. 
6. Hemorrhaging from the palatine artery and nasal cavity are controlled with ligation or digital pressure. 
7. Closure will be made using the full-thickness of the labial mucosal-submucosal flat using one or two layers. 

The partially dissected maxilla will likely be biopsied and sent to a laboratory. Collaborations with an oncologist will likely be sought later on as the histopathological results are made. 

Partial maxillectomy has good results for the resection of an oral tumor in cats. If the resection is confined to the dorsocaudal or free rostral portions of the maxilla, the prognosis remains very positive. 

After the partial maxillectomy is performed, postoperative pain is controlled through a combination of long-acting anesthetics, opioids, and NSAIDs (non-steroidal anti-inflammatory drugs). Antibiotics are not necessary if the feline is otherwise healthy, but a broad-spectrum antibiotic may be given to those with underlying disease. Water will be offered to the patient after anesthesia and the feline will be allowed a soft food diet 12 to 24 hours after surgery. Felines are often given an esophagostomy tube, which allows food to bypass the oral cavity and go directly to the stomach, to ensure proper nutrition. If skin sutures were placed, the feline will be reexamined two weeks postoperatively and a follow-up appointment will be set at about two to six months after the initial examination. 

The price a cat owner should expect to pay for a partial maxillectomy begins at about $325. Any biopsied tissues and postoperative medications should be added to this total surgical price, which is roughly an extra $50 to $100. 

When considering a partial maxillectomy for a cat, pet owners should be aware of possible surgical complications such as grooming difficulties, heat stress, ptyalism, prehension difficulties, postoperative dehiscence, and/or intraoperative hemorrhaging. Although common, the majority of the listed complications are short-lived and most cats adapt to the surgically altered area.  

A method for preventing the need for a partial maxillectomy in cats is unknown. Nearly 10% of all feline tumors are found in the oral cavity with squamous cell carcinomas being the most common type to inflict felines. These types of tumors are fast growing and the prognosis is grave, so early detection is vital in all cases.