Surgery for Head and Neck Cancer

Surgery for head and neck cancer

Surgical procedures for head and neck cancer have advanced dramatically in recent decades. Twenty years ago, surgery to remove the cancer and reconstruct the hole left behind might take more than 24 hours. Today, surgeons are able to remove head and neck tumors safely while reconstructing the surrounding tissues in as little as five hours, allowing for effective cancer treatment and minimizing difficult side effects. The vast majority of our patients, including those that are older, tolerate these procedures without issue.

However, these new surgical procedures are complex. To succeed, they require highly-experienced surgeons with advanced training in head and neck cancers. The surgery team at Washington University includes experts with training from all over the country, ensuring that our consensus opinion combines diverse expertise and skills.

The Washington University surgeons on the head and neck cancer team at Siteman see more patients than any other group in the region with over 8,000 patient visits per year. They have the skills, the tools, and the expertise to bring you the best outcome possible through their significant specialization.

Head and neck tumor removal

There are many different surgical procedures that can be used to treat tumors in the head and neck. The goal of every procedure is to remove the tumor with a surrounding border of cancer-free tissue called a margin. Achieving a clear margin helps prevent the cancer from coming back.

Your surgeons will select a procedure based on the location and size of your tumor. A laryngectomy, for instance, is used to treat tumors in the larynx, while a maxillectomy is used to treat tumors in the hard palate.

In some cases, head and neck tumors can be removed without making a major incision. For example, a small tongue cancer might be removed and simply sewed closed or even left to heal from the bottom up, called granulate. In other cases, surgeons may have to remove portions of bone or muscle to successfully treat a tumor, requiring reconstructive surgery to borrow tissues from the arm, leg, back, chest, or stomach to fill in what is missing and maximize function/appearance

Minimally-invasive techniques

At Siteman, our surgeons are skilled at using tools such as endoscopes, robotic arms, and even lasers to eliminate head and neck tumors either through the mouth or through tiny incisions. They will use minimally-invasive techniques whenever they can in order to reduce side effects and speed recovery.

Transoral laser microsurgery

Transoral laser microsurgery is a minimally-invasive technique used to treat early-stage oropharyngeal and laryngeal tumors. Surgeons extend a tiny laser through the mouth and into the throat and use it to cut tumors away from surrounding tissues. Because the structures of the larynx (voicebox) and oropharynx are crucial for speaking and swallowing, this technique can play a vital role in preserving the patient’s quality of life.

 Transoral robotic surgery

Transoral robotic surgery (or TORS) is another technique that allows throat tumors to be extracted through the mouth instead of through a large incision. During a TORS procedure, surgeons use a control panel to manipulate one or more robotic arms, which conduct the surgery inside the throat with the aid of a small camera.

Facial reconstruction

Sometimes, to remove a tumor, surgeons will have to extract the surrounding tissue and bone, such as the jaw.  This can impact a patient’s physical appearance. Fortunately, the Washington University surgeons on our team can often perform reconstructive surgery immediately after removing the tumor, treating the cancer and repairing the site in the same procedure.

Surgeons may use one or more techniques to reconstruct the face, head, or neck. Free tissue transfer, or the use of bone or tissue from another part of the body to rebuild the jawline, is a common practice. We use 3-dimensional CT scans to plan procedures, which helps us achieve excellent results and allows us to match the new bone with the old shape of the jaw.

Patients might also be fitted with a prosthesis, a synthetic replica of natural features. Siteman’s head and neck cancer team includes a prosthodontist, a dentist who specializes in making replacements for teeth and other facial structures.

The recovery process

The recovery process may be long or short, straight-forward or challenging, depending on the type of procedure performed and the extent of the cancer. Your Siteman care team will teach you how to care for any incisions before you are discharged from the hospital.

In more complex cases, we will provide information specific to your surgery through an app on your phone or tablet called CareOrbit®. CareOrbit® is an educational platform developed right here at Siteman to help head and neck cancer patients progress more smoothly through recovery and avoid readmission to the hospital after discharge.

Patients who are struggling with speech and/or swallowing will be referred to therapists who can help them regain their ability to function. It will take time to get accustomed to any changes. We are here for you and will do everything we can to get you back on your feet. If you need more help, we will work with you and your family to get the right level of support for you through other services.