Head and neck surgery

Oncological surgery for head and neck cancer is the indicated treatment for tumors removal and the area around it. It is one of the most used procedures, along with chemotherapy and radiation therapy. Know more.
Head and neck surgery

A lot of types of cancer located in the head and neck region can be cured, especially when discovered early. Although the elimination of the disease is the main goal of the treatment, function preservation of the nerves, organs and tissue in the region is also very important.

When planning the treatment, the doctor evaluates the tumor location and how the chosen approach may affect the patient’s quality of life, such as the way they speak (their voice), feed themselves, breathe, and even the aesthetic result.

Surgery is one of the main treatment options for head and neck cancer. It can be done alone or in association to radiation therapy, chemotherapy, and targeted therapies. Before deciding to go for it, the doctor assesses factors such as type and stage of the tumor, possible collateral effects and general health status of the patient. 

Types of surgeries for head and neck cancer

There are several types of surgery to treat head and neck cancer. Understand the main ones and for which cases they are indicated:

  • Laser surgery: can be used to treat an early-stage tumor, especially if it is located in the larynx;
  • Excision: technique that removes the tumor and part of the healthy tissue around it (the safety margin);
  • Lymph node dissection or neck dissection: if there is suspicion that the cancer have spread, the doctor may remove the lymph nodes (lymph glands) present in the neck. This procedure can be done together with excision;
  • Video-assisted surgery: procedure performed in a minimally invasive way, using a video system and delicate, fine forceps;
  • Flexible robotic surgery: minimally invasive treatment adopted in selected cases, in which the surgeon needs to access regions of the mouth and throat that are difficult to reach. It is done with the help of a flexible scope (a very thin tube);
  • Partial laryngectomy: used in the treatment of small tumors of the larynx, in which only the portion affected by the cancer is removed, leaving the rest of the larynx intact;
  • Total laryngectomy: adopted in more extensive laryngeal cancers, in which the total removal of the voice box is necessary. A tracheostomy is then performed, a process in which the trachea is surgically removed through an incision made in the neck to facilitate breathing. Patients undergoing this procedure have impaired speech, but on the positive side, liquids and solid foods can continue to be ingested normally;
  • Myocutaneous flaps: the throat is reconstructed using muscle and skin flaps located in a nearby area; and
  • Reconstructive plastic surgery: if the surgery to remove the tumor requires the removal of a large part of the tissue, such as in the jaw, pharynx or tongue, the doctor may include plastic surgery in the treatment. In addition to reconstructing the affected area, this type of surgery works on the aesthetic issue, leaving the appearance as natural as possible.

Other professionals can act in surgeries for head and neck cancer. This is the case of the prosthodontist (dentist specialized in dental prostheses, to develop a prosthesis that helps the patient to swallow food and to speak) and the speech therapist (specialist who can use techniques and equipment that help the patient to rehabilitate speech and the ability to feed themselves).

Possible adverse effects in surgery for head and neck cancer

The possible adverse effects of the surgery depend on the technique used and the location in which it was performed. The main ones are:

  • Temporary or permanent loss of voice;
  • Vocal cord injuries, which impair the way a person speaks;
  • Hearing loss;
  • Difficulty chewing and/or swallowing food;
  • Lymphedema (the accumulation of lymph fluid in fat tissue);
  • Decreased functioning of the thyroid gland (may occur after total laryngectomy, being corrected with the use of thyroid hormone); and
  • Swelling of the mouth and throat (making breathing difficult; if this occurs, a temporary tracheostomy may be performed).
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