Head & Neck

Reconstructive Surgery

Head and neck cancer treatment can substantially affect your quality of life, impairing essential functions such as your ability to breathe, speak, chew or swallow. Additionally, certain procedures may alter your appearance, which can affect you physically and emotionally. To improve your ability to perform these basic functions and to restore your appearance as much as possible, you’re encouraged to consult a skilled surgeon who has experience with head and neck reconstruction before beginning treatment, if possible.

The first step is typically a preoperative assessment to help your medical team determine the surgical or rehabilitative procedures that will best accomplish the desired goals. This is the time to ask questions and express your concerns about what is often a complex and lengthy process. Setting realistic expectations regarding the outcome will help you mentally prepare.

If reconstruction will involve replacing tissue, bone or skin, your team will also consider area(s) of your body to use as donor bone or tissue. Reconstruction may happen during your cancer surgery or may occur later, depending on the extent of the cancer and additional therapies planned.

Your surgical team may use one or more of the following procedures for reconstruction and rehabilitation.

Flap surgery. When treatment involves surgically removing tissue or bone, a “flap” procedure may be performed to replace missing tissue. Local flap surgery closes the wound left from removing the cancer by rotating or moving nearby skin or tissue. In regional flap surgery, tissue with an attached blood supply is rotated or moved onto the site from a site nearby. In free flap surgery, also called microvascular reconstruction, a specially trained surgeon removes a “flap” of tissue plus its feeding artery and vein from another part of the body. The surgeon uses this tissue to reconstruct areas in the head and neck, creating a new blood supply by sewing the flap’s artery and vein into an artery and vein near the wound.

Prosthetic rehabilitation. A prosthesis is an artificial replacement for part of your face or mouth (an ear, eye, nose, hard palate or teeth) that was removed during surgery to eliminate the cancer. A specialist called a maxillofacial prosthodontist will design a custom prosthesis specifically for you.

Tracheostomy. A surgeon creates a hole called a stoma or tracheostoma in the front of the neck and connects it to the trachea (windpipe). A hollow plastic tube is inserted to create a new airway to breathe through instead of the nose and mouth. In surgeries such as a laryngectomy (removal of the voice box), the stoma is permanent.

Dental rehabilitation. This may be recommended if your upper or lower jaw (maxilla or mandible) along with teeth were removed during surgery. Prosthetic (artificial) teeth can improve appearance and quality of life, as well as help you eat more normally.

Gastrostomy tube (G-tube). Some cancers and their treatments can affect the ability to swallow, which may make it difficult to get adequate nutrition. A gastrostomy tube inserted into your stomach through a small incision in your belly acts as a feeding tube, allowing you to receive liquid nutrition. Known as enteral (EN-teh-rul) nutrition, tube feeding may be your single source of nutrients, or it may be used to add them until you can eat enough by mouth. The tube may be removed when your ability to swallow improves (see Explaining Enternal Nutrition [Tube Feeding]).

 

Living With A Stoma

 

If your treatment plan includes a temporary or permanent tracheostomy, you will have a hole in your neck called a tracheostoma or stoma.

Adjusting to your stoma will take time. Be patient with yourself. Talk to your medical team, a therapist or other cancer survivors. Their practical advice combined with these suggestions may help ease the adjustment.

Bathing/showering If you prefer showers to baths, consider a shower shield, collar or stoma cover. Even the smallest amount of water entering your stoma can cause severe coughing.

Care Properly cleaning your stoma every day is very important. Because your breathing has been altered, your body may produce more mucus to compensate, which can plug your stoma. Before you’re discharged from the hospital, your health care team will provide detailed care instructions for your stoma and explain humidification and a heat and moisture exchange system (HME). Always follow these instructions.

Concealing With a little creativity, you can fashionably disguise your stoma. Mock turtlenecks tend to be comfortable and provide good coverage. Both men and women can wear different types of scarves, including bandanas. Jewelry can also help conceal it. Talk to others who live with a neck stoma for ideas or search online.

Coughing At first, it will feel strange to cough through your stoma, but most people adjust fairly quickly. Cover your stoma with a tissue when you feel the urge to cough to catch any mucus your cough produces.

Dentures If you have dentures, it’s important to wear them while you learn new ways of speaking. If they need to be refitted, visit your dentist before you begin speech therapy. Properly fitted dentures will help your mouth compress air to produce speech that’s more easily understood, so wear them except when sleeping.

Protection Wearing a stoma cover, especially outside, helps keep out microscopic substances in the air, such as pollen and dust, and reduces the risk of infection. Ask your health care team to recommend a stoma cover.

Sleeping Do not worry about being unable to breathe if your sheets or blankets cover your stoma while you’re asleep. Any interference with your breathing will automatically wake you.

 

Key Takeaways

  • Many reconstructive procedures may be available to help restore your appearance and improve your ability to perform key daily functions.
  • It is important for you and your doctors to agree upon the goal of your reconstruction plan.
  • Understanding how to use and care for your stoma will make it easier to adapt to this new way of breathing.

Additional Resources

 

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