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PAPS

HEAD & NECK CANCER

(mouth, tongue, cheek, jaw, throat, nose, neck)

Symptoms

Ulcers , bleeding wounds, decreased mouth opening, painful eating, weight loss

Description 

These cancers require multidisciplinary team management (ENT surgeon, Plastic Surgeon , Gastroenterologist and oncologist)

Patients usually require tumor excision along with lymph node dissection (surgery of neck) by ENT Surgeons. Plastic Surgeons reconstruct the defects of cheek, mouth and tongue and Jaw. These reconstructions usually (not always) require transplant of skin or bone from thigh, forearm, back or leg to the defect on face. Patients usually require a feeding tube to facilitate feeding after surgery and sometimes may also require tracheostomy (temporary airway tube from neck) to avoid any difficulty in breathing. 

Expected  complications 

Minor: wound infections, Marginal or partial necrosis (loss) of flap. Sometimes patient might need 2nd visit to operation theatre within 72 hours for urgent correction of blood vessels used for reconstruction of flap (re-exploration of flap)

Major:  Major wound infections , complete failure of flap which requires another surgery for reconstruction.

 

Expected outcome 

85- 90 percent cases recover smoothly

5 to 10 percent need re-explorations, minor wound complications

Less than 5 percent face complete necrosis (loss) of flap

Recurrence of tumor depends upon stage of tumor which can vary from 10 to 40 percent. 

Approximate duration of procedure 

5 to 10 hours (depending on extent of involvement and choice of reconstruction)

Approximate duration of hospital stay 

3 days to 1 week as in patient (with 1 to 2 days of Special care/ ICU setup)

Chances of success

90 to 95 percent

Alternate options 

Pedicled (local ) flaps in cases which lead to major flap loss. 

Long term effects 

Few cases might lead to trismus (decreases mouth opening ) if they fail to do aggressive mouth opening exercises. 

Patients always require regular follow up to observe any sign of recurrence  

 

Written by :  Dr. Safdar Ali

Copyrights: Pakistan association of Plastic Surgeons