When a section of the lower jaw is removed for cancer, the jaw loses its continuity and the chin can drift to one side. Reconstruction rebuilds the bone so the face keeps its shape and the mouth can close and chew.
Mandibulectomy reconstruction replaces the segment of lower jaw removed during cancer surgery. Most often a piece of the fibula, the slimmer of the two leg bones, is transferred with its own artery and vein, shaped to match the jaw and fixed with plates. This keeps the chin centred, supports the lower teeth and allows the mouth to open and close properly.
The lower jaw is a single curved bone that carries the lower teeth and hinges at both ends. When cancer involves the bone, a full section may have to be removed. Taking out that section leaves two loose ends, and without reconstruction they collapse inward, the chin swings towards the operated side and biting becomes almost impossible.
The usual solution is a bone flap. A length of the fibula is taken from the lower leg with its artery and vein, cut with precise wedges so it can be bent into the curve of the jaw, and fixed with titanium plates and screws. Skin attached to the same flap can line the inside of the mouth or resurface the outside of the face where needed. Vessels are then joined to vessels in the neck under a microscope.
Where bone is not required, or where a patient is not fit for a long operation, a plate alone with soft tissue cover is sometimes used instead. That is a reasonable compromise in some situations, though plates can loosen or become exposed over time, particularly after radiotherapy.
Suitability depends on the cancer plan, the condition of the leg vessels and your fitness for several hours of surgery.
Scans of the jaw and the leg vessels are reviewed with the cancer surgeon. The length of bone needed is estimated, and dental treatment that will be harder after radiotherapy is completed first.
The tumour and the involved section of jaw are removed with a margin. Neck glands are usually cleared in the same sitting, which also exposes the vessels for the flap.
A second team takes a length of fibula from the lower leg with its artery, vein and, where needed, a paddle of skin. Enough bone is left at each end to keep the ankle and knee stable.
The bone is cut with careful wedges so it follows the curve of the jaw, then held with titanium plates and screws. Position is checked so the teeth meet correctly.
Flap vessels are joined to neck vessels under a microscope and blood flow is confirmed. The mouth lining is repaired, drains are placed, and the leg wound is closed or grafted.
Close monitoring continues with regular flap checks. The leg is elevated and the foot circulation is watched. Feeding goes through a tube and the mouth is rinsed gently as instructed.
Swelling falls and drains are removed. Standing and walking with support usually begin in this period. Feeding by mouth restarts in stages once swallowing has been assessed.
Bone is uniting and walking is generally comfortable without support. Soft diet is tolerated. Radiotherapy, where advised, tends to start around this stage and needs the mouth kept very clean.
The jaw has consolidated and facial shape has settled. Dental implants may be discussed from this point. Regular cancer follow up continues under the oncology team.
Facial shape and jaw alignment usually improve markedly, though the reconstructed side may look slightly different and swelling settles over many months. Chewing power returns properly only after dental rehabilitation, which is a separate stage. The lower lip and chin are often numb and may stay that way. Walking generally returns to normal after physiotherapy, but a scar remains on the leg and some stiffness can linger for a while.
Two sites are operated on in one sitting, the jaw and the leg, so risks apply to both.
Two areas need attention at home, the mouth and the leg, and both have simple daily routines.
A section of the fibula can usually be taken without affecting walking, provided enough is left at the ankle and knee and physiotherapy is followed.
A plate can bridge the gap for a while, yet without bone it may loosen or become exposed over time, particularly after radiotherapy.
The bone restores shape and support. Chewing power depends on dental rehabilitation, which is planned as a later stage once healing is complete.
The nerve supplying the lower lip runs inside the jaw and is often removed along with the diseased bone, so numbness is expected rather than a mistake.
Jaw reconstruction at Elegance Clinic in Surat is planned with the cancer team, so bone shape, bite and later dental work are considered before the first incision. The family knows the plan, the stay and the estimate in advance.
The estimate reflects the length of bone reconstructed, the plates and screws used, the hours in theatre and the days spent in a monitored bed. Cases needing skin cover both inside the mouth and on the face sit higher.
A written estimate is issued once the plan is agreed with the cancer team. Dental implants are quoted separately at a later stage. Insurance and scheme cover is common for cancer surgery.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →Free flap reconstruction usually falls between Rs 1.8L and Rs 4.5L. The length of bone used, the plates required, theatre time and hospital stay all move the figure. A written estimate is prepared before admission once the plan is settled.
A section of the fibula can generally be removed without lasting effect on walking, since the larger leg bone carries the weight. Enough bone is left at the ankle and knee, and physiotherapy restores confidence over several weeks.
Feeding is by tube at first, then soft food once swallowing has been checked, usually within the first two weeks. Chewing firmer food comes much later and often depends on dental rehabilitation after the bone has fully healed.
Rebuilding the jaw keeps the chin centred and preserves lower face shape, which is a large improvement over leaving the gap. Some asymmetry usually remains, and swelling can take several months to settle completely.
Diabetes is not a barrier by itself, provided blood sugar is well controlled before surgery. Poorly controlled sugar raises the risk of infection and delayed healing, so the physician stabilises it before a date is fixed.
Radiotherapy usually starts once wounds have healed, commonly around four to six weeks afterwards, with the exact timing set by the oncology team. Dental work that would be difficult later is completed before radiotherapy begins.
The jaw and mouth are examined, scans and biopsy reports are reviewed, and the leg circulation is assessed. The operation, the donor site, the likely stay and later dental steps are explained, and a written estimate follows.
Each technique below has its own page explaining how it works and when it is chosen.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
