Head and Neck Cancer Reconstruction
Surgery resulting from cancer treatment is known as head and neck cancer reconstruction. Malignant tumors of the head and neck may involve the face, scalp, ears, nose, mouth, tongue, throat, and glands of the face and neck. Defects in the structure, and sometimes deficits in the function of head and neck organs may be affected. Treatment usually consists of surgical removal, sometimes combined with radiation therapy. Reconstruction after cancer surgery tries to preserve or restore both the appearance and function of the involved area.
How is it diagnosed?
The structural deformity will be obvious, in that it will alter the shape of the nose, lips, or other structures about the face. Functional disturbance will manifest as difficulty in breathing, chewing, swallowing, or problems of other structures about the face or neck.
What is treatment? Most frequently, head and neck cancer is on the skin surface, and relatively simple surgical removal and closure is possible. If the tumor is larger, or involves the eye-orbit, ears, nasal or oral cavity or upper digestive tract, more extensive surgical reconstruction by specialized techniques may be necessary. Every effort is made to restore form as well as function.
Why is it necessary?
Depending upon the location of the tumor, cancer surgery may result in significant deformities of the face, particularly if it involves the nose, lips, eyelids, and cheeks. Problems with eating, swallowing, speaking, and breathing may result from cancer treatment of the nose, mouth, and throat.
How is it done? Small tumors can often be closed by sewing the edges of the incision together. Larger defects may require skin grafts taken from other areas of the body. Alternatively, adjacent skin can often be shifted into position to fill the defect. Larger and deeper defects may require the transfer of muscle, bone, or skin flaps to close complex wounds of the nasal and oral passages, particularly when the cancer surgery has removed bone from the cheek or jaw. Microsurgery may be used to reconnect tiny blood vessels to provide adequate circulation to insure proper healing.
When is it done?
In many cases reconstructive surgery is performed at the time of cancer removal, often by the same surgeon. With large and complicated cancers, reconstructive surgery may be delayed until the pathologist can examine the tumor to make sure it has been completely removed. With some skin cancers, a dermatologist may remove the tumor and refer the patient to a plastic surgeon for reconstruction on another day. With complex tumors of the oral and nasal cavities, a two-team approach is often utilized, with one team responsible for removing the tumor, and the other dedicated to the reconstruction. This often shortens the length of the operation, since the reconstructive team can harvest the tissue from a different part of the body while the oncologic team is removing the tumor. Secondary reconstruction can be done on patients with longstanding deformities, or on those with residual deformity after their initial reconstructive procedure.
