Reconstructive Surgery for Head and Neck Cancer Patients

March 14 06:03 2025 Print This Article

Introduction

Head and neck cancers may involve the removal of important structures, including upper and lower jawbones, tongue, larynx (voice box), nose, salivary glands, and skin of the face and neck, causing disfigurement and difficulty in swallowing and speech. The goal of treatment for head and neck cancer patients is eliminating cancer, whereas the goal of reconstruction is restoring the function and appearance to the extent possible.

Treatment of head and neck cancers

Treating head and neck cancers may involve surgery for tumour removal, chemotherapy or radiation therapy. The treatment varies based on the location, size and stage of cancer, personal preference and general health of the patient. Although these treatments can help fight cancer and save a patient’s life, they can impair functions, such as swallowing, chewing and speaking or alter the appearance, which could be a constant reminder of the diagnosis.

Reconstructive surgery for head and neck cancer 

Tumour removal is usually followed by reconstructive surgery. Depending on the extent of surgical resection, the plastic surgeon aims to restore the appearance and basic functions as close to normal as possible by rebuilding portions of the head or neck, improving the patient’s quality of life. The reconstructive surgery can be done immediately after tumour removal or after cancer treatment (radiation or chemotherapy). A multi-disciplinary team of oncologists, reconstructive surgeons, speech therapists, physical therapists and psychologists is involved in the reconstructive surgery of patients with head and neck cancer. They customise the reconstruction plan based on the patient’s needs to achieve the desired outcomes both aesthetically and functionally.

Parameters for considering the most effective type of reconstructive surgery

• Surgery location and the degree of reconstruction required
• Previous surgery in the same area
• Individual preferences
• Reconstruction surgery can be delayed if further cancer treatment, such as chemotherapy or radiation therapy is needed
• Patient’s overall health and addressing co-morbidities, if any

Types of reconstructive surgery

Microvascular anastomosis or free tissue transfer

This advanced surgical technique is reliable for the restoration of surgical defects caused by tumour removal in the face and neck. Flap surgery refers to tissue transfer from a healthy body part (donor site), which may comprise the skin with the underlying muscle, tissues and blood supply, to the part where the defect requires repair (recipient). The tissues used can be muscle, bone, nerves, skin or a combination based on the reconstruction requirements.

In free tissue transfer, tissue is removed from a distant site in the patient’s body and transplanted onto the defect site in the head or neck region. Using a microscope, the flap’s blood vessels are sutured to the blood vessels of the head or neck region to establish a new blood supply for the flap’s survival.

This technique has allowed reconstructive surgeons to adopt an aggressive approach to tumour resection. The free flap technique permits the transfer of a large volume of tissue to the defect site and precision in reconstruction.

The free flaps frequently used for reconstruction are as follows:

• Anterolateral thigh (ALT) flaps (outer border of thigh) are used for mouth and throat cancers.
• Radial forearm flaps (lower arm) are recommended for mouth reconstruction.
• Fibula free flaps (lower leg). involves the transfer of bone from the lower leg for reconstruction. They are commonly used for jaw reconstruction. If the fibula is unavailable, latissimus-serratus-rib (part of the back and chest wall) free flap is used to transfer abundant amounts of bone, muscle and skin, although the bone quality is inferior to the fibula.
• Free muscle transfer involves the muscles harvested from the back or abdominal region for skull base reconstruction.

Local flap reconstruction

Local flaps are tissues harvested from areas surrounding the defect. Local flaps are favoured over free flaps due to an excellent match of colour and texture. They are commonly used for closure after the removal of small skin tumours.

Types of local flaps

Melolabial flap (flap next to the nose and lip)

It is used for the reconstruction of the oral cavity and oropharynx. The scar is concealed in the nasolabial crease.

Facial artery myomucosal (FAMM) flap

FAMM is a flexible and multipurpose flap used for tongue, palate and floor-of-the-mouth reconstruction.

Submental flap (facial artery branch)

It is easy to harvest and an option for N0 neck (absence of palpable lymph nodes)

Supraclavicular artery island flap

A thin and pliable flap harvested from the supraclavicular (located above and behind the clavicle and sternum) and deltoid regions (top of the shoulder) and used for oral cavity reconstruction as it matches its colour.

Infrahyoid flap (central portion of the anterior neck)

It is commonly used for the reconstruction of the floor of the mouth defects.

Platysma myocutaneous flap (PMF)

A flap comprising skin and muscle from the lower neck and used for oral cavity, lower face and neck reconstruction.

Regional flaps

When the tissue neighbouring the defect is inadequate or the local flaps cannot be used for closure due to large defects, regional flaps are obtained from the tissue near the defect (outside the head and neck region). Regional flaps are rotated into the recipient site while keeping its pedicle (the flap’s original blood supply is kept intact) secured at the base. Common regional flaps used in head and neck reconstruction include the pectoralis major flap (large muscle in the chest) used for the reconstructive surgery of oropharynx, oral cavity or hypopharynx and latissimus dorsi flap (back of the chest) used for reconstruction of large defects; they are pedicled flaps typically harvested as myocutaneous flaps (muscle and skin).

Reanimation of the paralysed face

This procedure restores the lost facial muscle strength and function following cancer therapy. Different techniques are used to reanimate muscles or restore appearance.

Static cosmetic procedure

This is performed to obtain facial symmetry. For example, a small platinum or gold weight is implanted in the upper eyelid to aid eye closure. The lower eyelid is simultaneously tightened to prevent dry eye and eye injuries. Eyelift is performed to adjust the brow of the paralysed eye to match the unaffected side. A facelift improves symmetry by tightening and lifting the skin and muscles on the side affected by nerve paralysis.

Nerve graft

Surgeons connect the paralysed face muscles to healthy nerve tissue obtained from another part of the face (neck) or body (leg). Muscle control slowly resumes on the paralysed side.

Muscle transposition and muscle transfer

In muscle transposition, the surgeon moves healthy muscle tissue from one part of the face to the paralysed side. Another option is to use muscles for chewing to enable the person to smile on the affected side. In the case of muscle atrophy (loss of muscle strength and mass), muscle transfer is performed where healthy muscle from another part of the body (leg) together with the nerve and blood supply is transferred on the paralysed side.

Most static cosmetic procedures for restoring facial symmetry are performed outpatient, and the patient can be discharged on the same day. For nerve graft, muscle transposition or muscle transfer, the patient is hospitalised for 2-3 days. Once muscle movement resumes, patients are referred to facial physical therapists.

Reconstruction of the jaw and facial bones

Bone grafts are recommended if the cancer has affected the jaw bones. Free bone transfer involves removing bone from the leg or shoulder to reconstruct the upper and lower jaw bones, eye sockets, palate or cheekbones. It restores the appearance and improves swallowing. If teeth are removed, dental implants are used for dental rehabilitation.

Another option is prosthesis where an anaplastologist develops a customised prosthetic nose, eyes, or ears when the original facial features are missing due to surgery or radiation. The prosthetics are made of silicone and merge into the face in texture, form and colour. The prosthetics can be affixed magnetically or using adhesives.

Skin grafting

This procedure involves the removal of skin from another area of the body (thigh) and placing it over the damaged area in the head or neck region. These are commonly used in tongue, buccal mucosa and floor-of-the-mouth resections.

Pre-operative preparation

• Assessment of general health, co-morbidities and risk factors
• Assessment of donor and recipient site
• Discussion of reconstructive surgery options and the recommended course of treatment
• Discussion of possible outcomes, risks and complications

Intra-operative steps

• Reconstruction is usually performed under general anaesthesia to provide patient comfort considering the complexity of the procedure and the long duration (approximately 10-14 hours).
• The tumour removal and harvesting of the tissue for transplantation at the defect site is usually performed simultaneously

Post-operative care

• Adequate medication is administered for pain relief for the wounds at the donor site and the head or neck region. Swelling may be present at the surgery site, which will gradually subside. Minor reconstructions require only 2-3 days of hospitalisation. In contrast, extensive reconstructions, such as jaw removal may require a longer hospital stay.
• Patients are encouraged to perform light exercises to prevent stiffness of the joints and regain full mobility. Therapists will be involved to help with the patient’s recovery. Depending on the type of surgery, exercises to improve jaw strength, shoulder strength, range of motion and posture will be a part of physical therapy.
• For patients who have undergone reconstruction that may affect swallowing or speech, speech and language therapists will use techniques to produce clear speech, promote safe swallowing and use communication aids, such as electrolarynx (device to produce clear speech).
• Patient should not smoke for at least 1 month after surgery.
• Symptoms such as fever, change in flap colour or excessive redness, pain or swelling at the surgery site should be immediately reported.
• Patients may need psychological support to address their disfigurement or functional loss.

Complications

• Minor complications, such as infection or bleeding may occur, which can be managed via antibiotics and local pressure (direct pressure on the injury), respectively.
• Major complications may include flap circulation problems, neck abscesses or salivary leaks. These may require a re-operation.
• Other complications could include anaesthesia risks, numbness, poor healing or haematomas (collection of blood outside the blood vessel).

Conclusion

The treatment modalities for head and neck cancer include chemotherapy, surgery or radiotherapy depending on the type and extent of the tumour. The defects following tumour removal may be large and extremely debilitating. As many of the defects are visible, plastic surgeons are involved in the reconstruction of defects following tumour removal to restore function (eating, speaking or breathing) and appearance. They use several techniques, including local, regional or free flaps; bone grafts; prosthetics; skin grafts or facial reanimation.

Reconstruction is usually performed immediately after tumour removal or after the completion of radiation therapy or chemotherapy. The recovery process depends on the type and extent of reconstruction, which affects the length of hospitalisation and rehabilitation. Although reconstructive surgery is a complex process, it improves the quality of life of patients after head and neck cancer treatment.

At Kauvery Hospital, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our expert team is dedicated to enhancing the lives of head and neck cancer patients through advanced reconstructive surgery. With a focus on restoring both function and appearance, we combine cutting-edge techniques with compassionate care to support our patients on their journey to recovery.

Frequently Asked Questions

What does reconstructive surgery for head and neck cancer involve?
Reconstructive surgery aims to restore appearance and function after tumor removal by using techniques such as free tissue transfer, local and regional flaps, bone grafts, and prosthetics.

When is reconstructive surgery performed after cancer treatment?
Reconstruction can be done immediately after tumor removal or following additional treatments like chemotherapy or radiation, based on individual patient needs.

How does free tissue transfer work in head and neck reconstruction?
This advanced technique transfers tissue (including muscle, bone, and skin) from a donor site to the defect site, reconnecting blood vessels under a microscope to restore both form and function.

What are the benefits of local flap reconstruction?
Local flaps use nearby tissue for reconstruction, offering an excellent match in color and texture, which is ideal for smaller defects and areas like the face.

How is facial reanimation achieved in patients with paralysis?
Facial reanimation can be performed through static cosmetic procedures, nerve grafts, and muscle transposition or transfer to restore symmetry and movement to the paralyzed face.

What should patients expect during recovery after reconstructive surgery?
Recovery involves hospital care, pain management, physical and speech therapy, and sometimes psychological support, with the duration depending on the surgery’s extent and complexity.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801