Head & Cancer Surgery

Ablative surgery is the removal of visible tumor with a margin of normal, healthy tissue that surrounds it. This form of surgery may also include the removal of lymph nodes from the neck which are involved by cancer. Common types of ablative surgery performed for head and neck cancers include glossectomy (removal of the tongue), mandibulectomy (removal of the jaw) and laryngectomy (removal of the voice box). Transoral robotic surgery (TORS) is a type of ablative surgery and is commonly performed for cancers of the oropharynx.

Ablative surgery is performed by a surgeon who is specifically trained in head & neck surgical oncology. This training is gained through residency training and an additional one to two years of head & neck surgical oncology fellowship; most ablative head & neck cancer surgeons are otolaryngologists, or ENTs. It is important to seek out a surgeon who has the necessary fellowship training and experience in performing ablative head & neck cancer surgery.

Reconstructive surgery involves the repair of a defect in the head & neck which is caused by ablative surgery. The goals of reconstructive surgery are to protect important structures and organs, maintain vital functions such as swallowing, speaking and breathing, and to restore appearance. Most commonly the reconstructive surgery is performed during the same operation as the ablative surgery.

This type of surgery is performed by a surgeon who is specifically trained in head & neck reconstruction. This training is gained through residency training and an additional one to two years of reconstructive surgery fellowship; most head & neck reconstructive surgeons are Otolaryngologists (ENTs) or Plastic Surgeons. It is crucial to seek out a reconstructive surgeon who has the necessary fellowship training and experience.

What are types of reconstructive surgery?

There are several types of reconstructive surgery, and the specific type is chosen based on a number of factors. These include a patient’s healing ability, aesthetic concerns, functional outcomes (breathing, speaking, swallowing), and the need to protect vital structures. Reconstructive surgeons follow the reconstructive ladder which is a series of methods that begins with the simplest (allowing the wound to heal on its own) and ends with free flap reconstruction (tissue transplantation from a remote site of the body). Your surgeon will discuss all options with you and your specific needs will be taken into account when selecting a reconstructive method.

What is free flap surgery?

Also known as microvascular reconstruction, this surgery is a form of tissue transplantation. A segment of tissue is removed with the artery and vein that provides it blood flow. This tissue is called a “flap,” and it is then used to reconstruct the defect left by ablative surgery. The artery and vein of the flap are then sewn under a microscope to an artery and vein near the wound using sutures that are finer than a human hair. The types of tissue that can be transferred include skin, muscle, bone, bowel either alone or in combination.

Free flaps require technical expertise, extra surgical time and very close monitoring after surgery to ensure that the tissue survives. If there are any issues with the blood flow to the flap after surgery, the surgeon must act quickly to identify and correct the problem.

The benefits of free flap reconstruction include the use of tissue that is not affected by radiation which has better healing ability than the tissue close to the cancer, the availability of multiple tissue types which can be used to rebuild certain structures, and the ability of the surgeon to precisely shape the tissue used to reconstruct.