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Head and neck cancers appear on visible parts of the body—so, naturally, people fear they might not look like themselves following cancer treatment. However, with the surgical techniques we use today, people often experience very little scarring after their cancer is removed.
The most common type of head and neck cancer is called squamous cell carcinoma, which accounts for about 90 percent of all cases and can affect the:
- Back of the throat
- Inner surface of the cheeks
- Jaw bones
- Saliva glands
- Voice box
Former Buffalo Bills quarterback Jim Kelly had a public fight against head and neck cancer, specifically cancer in his upper jaw bone, or maxilla. After his cancer recurred after receiving chemotherapy and radiation therapy, Kelly underwent surgery to remove his upper jaw bone. His upper jaw was reconstructed using a fibula free flap, which is when a piece of bone and tissue from the fibula supplied by an artery and vein is used to replace the missing upper jaw bone. The artery and vein from the flap are connected to an artery and vein in the neck, providing the tissue with its own blood supply. After receiving dental implants months later to replace teeth that were removed during surgery, Kelly now talks and eats normally, looks about the same as he did before surgery, and remains cancer-free.
LISTEN: Dr. Giurintano discusses reconstructive surgery for head and neck cancer in the Medical Intel podcast.
How Reconstructive Surgery for Head and Neck Cancer Works
Many years ago, we could remove patients’ head and neck cancers, but we couldn’t reconstruct the areas where cancer was removed, which often led to noticeable deformities or scars. However, today’s techniques allow patients to experience much less cosmetic and functional deformity.
Free-flap surgery—when we transfer tissue from one part of the body to another—is the most common technique we use. During a free-flap surgery, we remove the cancer and reconstruct the resulting defect at the same time, with one surgeon removing the cancer and the other harvesting and placing the flap. The free flap surgeon uses a microscope to sew an artery and vein from the flap to an artery and vein in the neck, which provides the transplanted tissue with its own blood supply. This is important because many people later receive radiation therapy as part of their treatment, and without a robust, healthy blood supply, non-vascularized tissue dies from radiation therapy. Surgery typically takes about six to 10 hours, a far cry from the 24 hours it took 20 to 30 years ago.
Free-flap surgery for head and neck #cancer has come a long way over the years. In fact, surgery typically takes just six to 10 hours today, compared to 24 hours 20 to 30 years ago. https://bit.ly/2XVa53X via @MedStarWHC
Who Is a Candidate?
To determine if an individual with head and neck cancer is an ideal candidate for a free flap, we perform tests such as angiography, which examines blood vessels through an X-ray to ensure that they are healthy enough to support a free flap. This is especially important when we do a fibula flap, as we have to ensure that a person has the standard three blood vessels that supply blood to the leg. In rare cases, patients do not have three vessels supplying the foot, so we have to consider alternative options, such as the rib or scapula (shoulder blade).
Additionally, we consider a patient’s’ lifestyle. For example, if a patient is a pianist, we prefer to remove skin from their leg or hips rather than their forearms or wrists, as it could interfere with their ability to play.
What to Expect During Recovery
Following free-flap surgery, patients typically spend two days in the intensive care unit, as we closely monitor their blood vessels to ensure clots do not form. Then patients usually spend three to five days in a regular inpatient setting, where they can also receive physical therapy to help them maintain or restore their strength. Once patients return home, it normally takes them another couple of weeks for a full recovery, which includes rehabilitation of swallowing, speaking, and other normal activities.
Depending on the severity of the case, some patients return home and require minimal follow-up care, while others occasionally need feeding tubes or tracheostomy tubes, which are inserted into the neck to provide an air passage to help people breathe when the usual route for breathing is obstructed or impaired due to too much swelling. Additionally, some patients can experience difficulty swallowing. Because we are concerned that they might accidentally aspirate their foods, we help facilitate nutrition while they’re recovering by placing a tube into the stomach for about six to eight weeks or until their neck has fully recovered.
Expert Care at MedStar Washington Hospital Center
We use a team approach at MedStar Washington Hospital Center to treat head and neck cancer, which includes surgeons who remove the cancer, reconstructive surgeons who repair the affected skin, and facial plastic surgeons who can perform additional cosmetic surgery. We also work with colleagues in the departments of radiation oncology and medical oncology, as many cases of head and neck cancer require radiation therapy or chemotherapy.
We have regular meetings in which surgeons, medical oncologists, radiation oncologists, speech pathologists, and radiologists meet to discuss new cancer patients and patients who recently had their cancers treated. During this meeting, we bring all of our expertise together to stage each patient’s cancer and determine the best treatment plan for them.
Reconstructive surgery for head and neck cancers has come a long way over the years. Patients now can not only treat their cancer but also experience very few changes to their appearance and daily lives.