Mandibulectomy Surgery Consent Form

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Mobile Veterinary Surgeon Dr. Paul Newman 615-519-0647

Mandibulectomy Surgery Consent Form
Your pet has a tumor or condition of the mandible (jaw bone) that requires removal of the mandible (hemi or segmental mandibulectomy). Complications from this surgery are common but most are minor and resolve in time. Although some patients have a poor cosmetic appearance, the vast majority of owners find the final appearance to be acceptable. Your pet will be able to eat, drink, and bark normally after a short adjustment period. Cosmetic reconstruction can be attempted if the results are unacceptable to you, but this is rarely necessary. Occasionally, plastic surgery of the lip (cheiloplasty) can be done if drooling or lateral protrusion of the tongue is severe and bothersome. If your pet has a benign tumor (acanthomatous epulis) or non-healing fracture, this surgery is usually curative. If your pet has a cancerous growth, recurrence or metastasis may occur even with surgery. The closer the tumor is to the front of the mouth, the lower the recurrence rate in many instances.
The undersigned owner or authorized agent of admitted patient _____________________ hereby authorize the admitting veterinarian (and his/her designated associates or assistants) to administer such treatment as is necessary to perform the below-mentioned procedure. The nature of the procedure(s) has been explained to me and no guarantee has been made as to results or cure. I understand that there may be risk involved in these procedures.
I consent to the administration of such anesthetics or tranquilizers as are necessary.
Anesthetic Risks: (Although every effort is made to make anesthesia as safe as possible including vital sign monitoring and use of the most up to date anesthetic agents and equipment, I understand that anesthesia carries inherent risks) The incidence of complications from anesthesia are extremely low and we do not anticipate any complications in your pet but on rare occasions the following can occur:

  1. Allergic reaction to the anesthetic agents

  2. Heart rhythm abnormalities

  3. Untoward reactions to the gas including drops in blood pressure or respiratory difficulties

  4. Just like in humans, on very rare occasions, general anesthesia can result in death.

We are prepared and will treat any anesthetic reactions if they occur, but general

anesthesia is never completely without risk.
Procedure: Hemi-mandibulectomy
Surgical Risks:

  1. Infection or dehiscence of the incision site

  2. Regrowth of tumor

  3. Salivary mucocele (blockage in the salivary duct that leads to backup and pocketing of saliva in a sac under the tongue). Most of the time these resolve on their own but occasionally we need to remove the salivary gland in a future surgery.

  4. Drooling of saliva on the side of the surgery after eating or protrusion of the tongue.

  5. Mandibular drift (the mandible deviates to the side) causing malocclusion of the teeth, clicking of the teeth, and/or trauma to the oral tissues.

  6. Sometimes the appearance of the face is unacceptable to you and cosmetic reconstruction may be attempted.


Date Pet Owner/Agent Signature Phone I Can Be Reached At Today

Client Information Series # 94

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