Head & Neck

Reconstructive Surgery

If large areas of cancer and surrounding tissue will be removed to treat your head and neck cancer, you may need reconstructive surgery. For this surgery, you will work with a team of surgeons that includes both an ablative surgeon, who removes the cancer, and a reconstructive surgeon, who performs complex reconstruction of the defect that results from removal of your cancer. 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. Your surgical team will consider other areas of the body that will serve best as donor sites for tissue used for reconstruction.

In general, your reconstructive surgery team strives to accomplish three goals.

  1. Protect vital structures. Covering important structures with healthy tissue protects them from potential life-threatening damage.
  2. 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 these vital functions.
  3. Restore appearance. Your quality of life, including your ability to work and enjoy family activities, may be affected 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, tissue, bones and tendons from distant areas of the body to reconstruct the complex function and shape of the head and neck. Sometimes 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.

Different strategies involved with reconstruction 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). A hollow plastic tube is inserted through this hole and helps you breathe by letting air in and out of the lungs. The procedure is often only temporary, but some head and neck cancer surgeries, such as laryngectomy, may leave you with a permanent stoma.
  • Gastrostomy tube (G-tube). Cancer of the throat can affect your ability to swallow. If difficulty swallowing prevents you from getting enough nutrition, you may need a gastrostomy tube, which is a feeding tube placed into your stomach through a small incision in your belly. One type of G-tube is the percutaneous endoscopic gastrostomy (PEG) tube, which is placed with a thin, flexible tube-like instrument called an esophagoscope. Special liquid food is given through the tube. It can often be removed after therapy once you are able to swallow better.
  • Prosthetic rehabilitation. A prosthesis is a synthetic replacement of part of your face or mouth that has been removed by 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 laryngectomy (removal of the voicebox), you will need to adjust to life with a 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 recommendations will help you prepare for living with a stoma.

  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.

  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 about how to clean your stoma daily.

  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 to 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 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.

  Coughing

Although coughing through your stoma instead of your mouth might seem strange at first, you will probably adjust fairly quickly. Use a tissue to 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.

  Dentures

Your surgeon will tell you when you can resume wearing your dentures after surgery. 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.

  Protection

Wearing a special protective cover over your stoma may help keep out substances in the air. Talk to your health care team about the best option for you.

  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.

In addition, to help you manage the emotions you may be feeling, talk with your medical team, a therapist or other survivors. Their advice and support may help you adjust to your new normal.

 

Additional Resources

 

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