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Reconstructive surgery after head and neck cancer treatment

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on May 19, 2022.

If you’ve been treated for head or neck cancer, your doctor may recommend reconstructive surgery to improve the cosmetic and/or functional outcomes of certain procedures.

Removing cancer in or around your cheeks, for example, may leave a gap that can be disfiguring and serve as a constant reminder of your diagnosis. Through advances in technology and techniques, reconstructive surgery can help fill the cheek area, improving its look and aiding your emotional recovery. Or if surgical treatment of tongue cancer makes it hard to swallow afterward, rebuilding your tongue can help restore this function.

What is head and neck cancer?

Head and neck cancers may be found inside your nose, throat, mouth, larynx (voice box) or lips, including near or in your nasal cavity or salivary glands. These cancers tend to start in the squamous cells that line the surfaces of your head and neck.

Treating head and neck cancer

Treatment likely involves surgery to remove the tumor and/or radiation, chemotherapy or newer cancer drugs that either harness the power of your immune system to fight cancer (immunotherapy) or take aim at common genetic mutations found in the cancer (targeted therapies) to get rid of errant cancer cells. Your cancer care team can develop a treatment strategy based on your cancer’s location and stage, as well as on your overall health and preferences.

Surgery and other treatments to remove the head and neck cancer may save your life, but they can also leave you disfigured and/or impair some basic functions, such as chewing, talking, swallowing or breathing.

You don’t have to make decisions about reconstructive surgery right away, but your cancer care team will likely discuss the possibility when going over your cancer treatment plan.

Reconstructive surgery: What to know

Reconstructive surgery—typically performed by a reconstructive/plastic surgeon or an oral and maxillofacial surgeon—can make a big difference in your appearance and improve a function that was lost or compromised by cancer treatment. Other experts may also be involved in the process based on the type of surgery or surgeries being performed. If you’re getting dental implants, for example, a team consisting of a dentist, oral surgeon, periodontist, prosthodontist and/or endodontist may be needed.

There are many types and combinations of reconstructive surgeries based on the cancer’s location, extent and treatment. Sometimes, more than one operation is necessary to achieve the desired results.

In general, your surgeon may use skin, bone, muscle, tissue, nerve grafts or implants to correct any issues. Such grafts can be taken from other parts of your body or from a donor, and some can be man-made.

Below is a list of some reconstructive techniques used after head and neck cancer treatment.

Reconstructive options for throat cancers

Free flap reconstruction: This procedure involves taking tissue from one part of your body—usually farther away from the treated area, such as a piece of intestine or arm muscle—and transplanting it to the throat. The tissue may be muscle, bone, skin, nerves or a combination, depending on what is being reconstructed. For it to be successful, your surgeon must also transfer blood vessels to establish a new blood supply to the transplanted flaps so that they can survive.

Local flap reconstruction, or myocutaneous flaps: Your surgeon moves tissue from one part of your body (the donor site) to the surgical site (the recipient site). The tissue is usually taken from a neighboring location, which means it can be adjusted to cover the affected area, and comes with its own blood flow. A surgeon may partially detach a muscle in your chest (or another muscle near the throat), along with a piece of adjoining skin, and then flip it over the affected area.

Reconstructive options for nasal and sinus cancers

Nose reconstruction and prosthetics: If the nose is removed or damaged during treatment, there are several options available to reconstruct or replace it. Tissue grafts are one option, which involve taking tissue from another area of the body and using it to recreate the nose. Prosthetics may also be an option. A prosthesis is an artificially made body part. Prosthetic noses are made of artificial materials such as plastic and are customized to each individual and their skin tone.

Hard palate reconstruction and prosthetics: If the roof of the mouth (hard palate) is removed or damaged during treatment, surgeons can replace it using a piece of soft tissue (such as a muscle or tendon) taken from elsewhere in the body. A bone graft may also be necessary if cancer has invaded the jaw. A bone graft follows the same general procedure as a tissue graft, but involves moving a piece of bone rather than soft tissue. A prosthetic can also be used to replace the hard palate. Hard palate prosthetics are custom-fitted to each patient and may help restore or improve functions such as speaking and swallowing.

Reconstructive options for mouth cancers

Skin grafts to repair minor damage in the mouth: If only minimal surgery to remove small tumors is needed, the damaged areas can usually be repaired with skin grafts. Skin grafts are pieces of skin removed from another area of the body, such as the thigh. A surgeon will remove a slice of skin and bring it to the damaged area in the mouth, throat or neck, where it can be used to replace any structures harmed during treatment.

Free flap reconstruction to fix larger problems: To repair damage in the mouth or jawbone, surgeons can take out pieces of muscle, bone, skin or nerves from another area of the body and transfer them to the mouth area. Surgeons can often reconstruct half of the tongue using this approach, and also help improve swallowing and speech ability in the process. If flap procedures aren’t possible with your own tissue, custom prosthetics may be an option.

Other reconstructive options for head and neck cancers

Facial reanimation reconstructive surgery: This type of surgery aims to restore facial muscle strength and function that may have been lost due to cancer treatment. It typically involves the use of muscle and nerve grafts. You will likely need physical, occupational and speech therapy as part of your recovery.

Skull base surgery: If your surgeons removed cancer from the base of your skull, the area may need to be reconstructed using free or local flaps to help restore facial nerves and counteract facial weakness or paralysis. Neurosurgeons are often involved in planning and performing skull base surgery.

Preparing for reconstructive surgery

Your surgical team will give you the details about what you can and can’t do before reconstructive surgery. This should include written information about eating, drinking and taking medication. Following these instructions closely will help minimize some of the risks associated with this surgery.

All surgeries do confer some possible risks, including:

  • Infections
  • Blood clots
  • Complications from anesthesia

Your surgical team can review care instructions with you before and after surgery, so you know what to be on the lookout for and what to do. Your care team can also tell you what to expect during your recovery and which types of services you may need to help you regain lost functions. This may include physical, speech or occupational therapy.

Recovering from reconstructive surgery

Downtime, recovery and rehabilitation needs may all vary based on the extent of your surgery. Minor reconstruction, such as a local flap procedure, may require a couple of days in the hospital, while more extensive surgery may involve a longer hospital stay and more downtime.

Make sure you have a contact number to get in touch with your surgeon should a complication develop during the recovery period. As with pre-op instructions, following all recovery instructions will help maximize the outcome of your procedure and minimize risks. Your surgeon can also tell you when you can expect swelling and bruising to go down. If something isn’t clear or doesn’t look or feel right, don’t be afraid to ask questions.

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