by admin-blog-kh | March 14, 2025 6:03 am
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.
Treating head and neck cancers may involve surgery for tumour removal[14], 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.
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[15], 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.
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[18] 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:
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.
It is used for the reconstruction of the oral cavity and oropharynx. The scar is concealed in the nasolabial crease.
FAMM is a flexible and multipurpose flap used for tongue, palate and floor-of-the-mouth reconstruction.
It is easy to harvest and an option for N0 neck (absence of palpable lymph nodes)
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.
It is commonly used for the reconstruction of the floor of the mouth defects.
A flap comprising skin and muscle from the lower neck and used for oral cavity, lower face and neck reconstruction.
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).
This procedure restores the lost facial muscle strength and function following cancer therapy. Different techniques are used to reanimate muscles or restore appearance.
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.
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.
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.
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.
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.
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[21] 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.
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
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