Head & Neck

Reconstructive Surgery

If large areas of cancer and nearby tissue were removed to treat your head and neck cancer, you may need reconstructive surgery. For your reconstructive surgery, you will work with a team that includes a medical oncologist, ablative surgeon, microvascular surgeon and reconstructive specialist, among others. Before recommending the type of surgery that best meets your needs, your doctor will perform a preoperative assessment and consider the tumor stage and prognosis, as well as your age, sex, general health and functional status. Available reconstructive donor sites also will be considered.

In general, the team behind your reconstructive surgery strives to accomplish three goals:

  • Protect vital structures. This involves separating nonsterile areas, such as the mouth, throat and nose, from sterile areas, such as the neck and brain. Covering important structures with healthy tissue protects them from potential life-threatening damage.
  • Restore function. Sometimes removing tumors affects how your body works, including breathing, eating, chewing and swallowing. A reconstructive surgeon will try to restore function as much as possible. After surgery, you will work with a team of therapists to relearn those crucial abilities.
  • Restore appearance. Your quality of life, including your ability to work and join in family activities, may be influenced if you are not comfortable with your appearance. Reconstruction can improve your self-image, making you more comfortable going out in public and resuming your daily activities.

Reconstructive techniques range from using small amounts of tissue from areas near the surgical site to using skin, bones and tendons from distant areas of the body to reconstruct the complex function and contours of the head and neck. Sometimes tissue from another part of the body is used, and other times artificial dental or facial parts, called prosthetics, are used.

Head and neck surgery can affect you physically, nutritionally and emotionally. Talk with your reconstruction team about what to expect before surgery so you can mentally prepare for the time it may take to regain important functions and feel comfortable with your appearance. Keep in mind the reconstructive process is complex and won’t happen overnight, so it is important to be patient.

Other types of reconstructive strategies include the following:

  • Tracheostomy. In this procedure (also called a tracheostoma), a surgeon makes a hole (stoma) in the skin at the front of your neck and connects it to your trachea (windpipe). This helps you breathe by letting air in and out of the lungs. The procedure can be temporary after a partial pharyngectomy or permanent after a total laryngectomy.
  • Gastrostomy tube (G-tube). Cancer of the throat can affect how you swallow. If trouble swallowing prevents you from getting enough nutrition, you might need a gastrostomy tube, which is a feeding tube placed through your belly skin and muscle into your stomach. This percutaneous endoscopic gastrostomy (PEG) tube is placed with a thin tube-like instrument called an endoscope. Special liquid food is given through the tube. It can be removed once your swallowing function is better.
  • Prosthetic rehabilitation. A prosthesis is a synthetic replacement of part of your face that has been affected by ablative surgery, such as the eye, ear, nose, hard palate (roof of mouth) or teeth. The prosthesis is made from a special material and is designed and created specifically for you by a specialist, called a maxillofacial prosthodontist. Special training is given on how to use the prosthetic.
  • Dental rehabilitation. When the upper jaw (maxilla) or lower jaw (mandible) is removed along with teeth, you might consider dental rehabilitation. This is the placement of prosthetic teeth to improve your appearance and quality of life, as well as help you eat normally.
 

Living With A Stoma

If you have a tracheostomy or a laryngectomy, you will need to adjust to life with a tracheostoma (or stoma), which is a hole made in your neck and trachea (windpipe). A surgeon will permanently separate your windpipe from your esophagus and attach it to the stoma, which means you will breathe through it instead of through your nose or mouth. Your medical team will teach you about humidification (the process of adding moisture to the air) and a heat and moisture exchange system (HME) while you’re still in the hospital.

These helpful tips will help you prepare for living with a stoma:

  • Care. Proper cleaning of the stoma is very important. Your breathing will be altered, and your body might compensate by producing more mucus which could form a plug in the stoma. Your medical team will give you detailed instructions for how to clean your stoma daily.
  • Coughing. Although coughing through your stoma instead of your mouth might seem strange at first, you will probably adjust fairly quickly. Cover your stoma instead of your mouth when you feel yourself about to cough. This will help you catch any mucus produced by your cough.
  • Protection. Wearing a special protective cover over your stoma may help keep out foreign matter. Talk to your health care team about the best option for you.
  • Bathing/showering. It won’t take long to become comfortable bathing and showering with your stoma. Severe coughing can result from even the smallest amount of water entering the stoma, so you may choose to wear a shower collar or shield to help protect it.
  • Sleeping. Although you might be fearful of sheets or blankets covering your stoma as you sleep, you shouldn’t worry about any danger. Any interference with your breathing will wake you immediately.
  • Dentures. As you learn new ways of speaking, it’s important to keep wearing your dentures. Properly fitted dentures help the mouth compress air to produce speech that is more easily understood. Keep your dentures clean and in your mouth at all times, except for at bedtime. See your dentist before you begin voice lessons if your dentures need to be refitted.
  • Clothing. As you grow more comfortable with your stoma, you will likely need to adjust your wardrobe, both to protect your stoma as well as fashionably disguise it. Each person’s style is different, so find what works best for you. Mock turtlenecks tend to be comfortable with good stoma coverage, and many scarves now can be worn by both men and women. Many jewelry options are available to help conceal your stoma. Talking to other people who have stomas may help you find a style that works best for you.
 

Additional Resources

 

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