Partial Maxillectomy in Dogs

A partial maxillectomy is a surgical procedure your veterinarian may perform if disease or damage is present on your dog’s upper jaw. Maxillectomy involves the removal of the bone and tissue in your dog's upper jaw. This procedure becomes necessary when damage from trauma occurs, chronic infection is present, benign tumors interfere with jaw functioning or malignant tumors occur on the upper jaw that require immediate removal before they spread and become life-threatening. There are several types of partial maxillectomy depending on what portions and structures of the upper jaw are removed they include:

• Rostral, the partial removal of the rostral upper jaw on one or both sides
• Total hemimaxillectomy, removal of the entire dental arch on one or both sides and part of the palate
• Central hemimaxillectomy, removal of the central portion of the maxilla (upper jaw bone)
• Caudal hemimaxillectomy, removal of the rear portion of the upper jaw bone

Up to 50% of your dog's upper jaw can be removed if necessary and still allow your dog adequate functioning. If partial maxillectomy is required it will be performed under general anesthesia by a qualified veterinary surgeon.

This procedure is performed under general anesthesia. If possible, intravenous anesthesia followed by anesthesia with an intubation tube will be used providing the upper jaw surgical site can be accessed with intubation tube in place. Intravenous anesthetic and local anesthetic may also be used. If neoplasia exists the tumor will be removed along with tissue margins of at least 1 cm for malignant tumors, preferably more, and 1 cm or less for benign conditions will be required.

Once under anesthesia, incisions are made to access the upper jaw bone. Vessels will be ligated as required. Tumors, infected tissue, and bone are removed. Bone is removed using surgical bone saws, drills, chisels or wires as appropriate for the area being removed. Any teeth attached to the bone being excised will also be removed. Bleeding will be controlled with gentle manual pressure. If the nasal passage is uncovered during surgery it will be checked for signs of disease and affected tissues and structures removed as required. The oral nasal passage will be closed with mucosal tissue harvested from the nearby oral cavity. Repairs conducted with mucosal tissue should utilize flaps larger than the cavity, involve non-tension sutures conducted using healthy tissue over bone for the best results. Cancerous tissue and healthy margins excised will be sent for analysis at a laboratory to verify cancerous cells present and ensure adequate tissue margins were removed. Incisions are closed and your dog will be put into recovery. Your dog will require hospitalization for two to four days for monitoring and supportive care. Monitoring  will be provided to watch for hemorrhaging and to ensure your dog can breathe adequately post surgery, especially if nasal cavities were invaded. Supportive care consists of intravenous fluids, antibiotics, and pain medication. Your dog will be kept under veterinary supervision until they are able to eat and drink on their own. At this time your dog will be carefully monitored to ensure the wound does not rupture (dehiscence).

Partial maxillectomy is curative for benign conditions. For malignant neoplasm, prognosis is guarded due to the aggressive nature of oral cancers. Partial maxillectomy may be palliative to provide relief for your dog's condition and increase their remaining time. Partial maxillectomy combined with radiation or chemotherapy for dogs with cancerous lesions may provide a more effective outcome.

Soft food should be fed for at least two weeks post-surgery. Hand feeding soft or liquefied food may be effective. A feeding tube may be used post surgery depending on the invasiveness of the procedure performed. The oral cavity will need to be flushed out with a sterile solution and pain medications administered if prescribed. Monitor the surgical site for complications such as bleeding or infection. Bleeding can usually be seen in your dog's water if it is occurring. Avoid manipulating your dog's oral cavity more than necessary. The skin flap may move during breathing, this will usually resolve within a few weeks of surgery as tissue establishes. Check to ensure that remaining teeth do not interfere with the surgical site during normal usage and contact your veterinarian if they do. Your will need to follow up with your veterinarian after two weeks for suture removal and post-surgery examination, and periodically for several months post surgery to ensure healing and functioning of the jaw resumes. A muzzle to prevent your dog from handling objects with their mouth and an e-collar to prevent your dog scratching or interfering with their mouth during recovery will often be recommended. If malignancy was discovered, follow-up treatment with radiation or chemotherapy may be scheduled. 

The cost of partial maxillectomy including radiographs conducted prior to surgery, anesthetic, procedure, and hospitalization can be expensive and will vary widely depending on the extent of procedure required and the recovery of your dog. Partial maxillectomy ranges from $1,500 to $4,000. Chemotherapy and radiation treatments are in addition to this cost.

Because the upper jaw has less available tissue for reconstruction, wound dehiscence can be a major problem with upper jaw surgery. Oronasal fistulas can result if wounds rupture and allow communication between the oral and nasal cavities. These will need to be repaired by subsequent surgeries to prevent respiratory complications from occurring. Close monitoring will be required to recognize this complication and address it immediately should it occur.

You can expect some change in the cosmetic appearance of your dog, however adequate functioning should remain. Most dogs are content to have relief from painful conditions and as long as they can function they are not concerned about appearance.

Although prevention of oral tumors is not presently understood, regular dental care will help to reduce periodontal disease that could result in infection in the upper jaw and will help identify neoplastic lesions at an early stage when surgical invasiveness will be minimized. In addition, avoiding fractures or trauma to your dog's jaw that could result in unresolved fractures or infection will reduce the likelihood of requiring partial maxillectomy in your dog.