289Indications for total mandibulectomy in the dog include large or invasive neoplasms, salvage following severe trauma, osteomyelitis unresponsive to medical management, and cyst formation. 1,2,9 Oral neoplasia is the most common reason for performing mandibulectomy. 2 Approximately 6 % of oral tumors in the dog are malignant. 4 Malignant neoplasms generally require more aggressive margins (1 -2 cm), often making mandibulectomy the surgical treatment of choice. 5,6 Before definitive surgery, laboratory tests should be done including a complete blood count, serum chemistries, urinalysis, coagulation time, and cross-match if indicated. Three-view thoracic radiographs should be performed to rule-out thoracic metastasis for malignant mandibular lesions.Intraoperative diagnostic procedures include a complete oral examination and charting of the entire oral cavity. Mandibular radiographs are required in order to assess bony changes associated with the lesion. 6 Advanced imaging (magnetic resonance or computerized tomography) provides superior assessment of pathologic changes. 6,7 Incisional biopsy and histopathologic assessment will aid in appropriate treatment planning. A thorough preoperative work-up provides valuable information that affects the surgical plan, prognosis, and adjunctive therapy. 6 These results must also be considered by the owner before consent for a major surgical procedure that has some degree of morbidity.Preparation for surgery includes a review of relevant anatomy including the location of major neurovascular structures in the operative field. 5 Meticulous surgical technique should be used when performing these procedures including sharp dissection, delicate tissue handling, maintenance of neurovascular structures when possible, and a tension-free wound closure. 8 Postoperative management includes multi-modal analgesia and antibiotic therapy for 7-days. 9 Most patients are able to resume mastication immediately postoperatively, avoiding the need to place a feeding tube. 5,9 A soft food diet is recommended for the initial 2-weeks following surgery during the early phases of primary wound healing.Complications following total mandibulectomy include difficulty with eating and drinking, excessive salivation, wound dehiscence, and mandibular drift can result in palatal trauma from the remaining mandibular canine tooth. 2,6,9 However, crown reduction and vital pulp therapy will avoid this latter complication 9 and should be performed during the same anesthetic episode as the mandibulectomy. Generally, the outcome following this procedure in dogs warrants a good prognosis for function with many types of oral neoplasms being curable with the application of this aggressive surgery. 9,10 The prognosis may be enhanced when adjunctive therapies are administered postoperatively. 10 In summary, mandibulectomy should be a technique in the armamentarium of all veterinary dentists performing oral oncologic surgery and is described here step-by-step.
Figure 1Photograph of a canine cadaver placed in sternal recu...
