About surgery for head and neck cancers

Surgery is one of the main treatments for cancers of the head and neck. The type of surgery you have depends on the size and position of the cancer, and whether it has spread.

The aim of surgery is to remove the cancer completely. Your surgeon will also do everything possible to minimise the changes that surgery may cause to your speech, swallowing, breathing, or facial appearance.

Before your operation, your surgeon will discuss the surgery with you. It is important that you understand what they are going to remove and how this will affect you after the operation, in the short and long term.

They will tell you how to prepare for surgery. As your speech, swallowing or eating could be affected, you may meet with a speech and language therapist (SLT) or dietitian, before the operation.

Types of surgery for head and neck cancer

Transoral surgery

If you have a small cancer in the mouth, it may be possible to do surgery through the open mouth. This is called transoral surgery.

Transoral surgery does not leave any scars on the neck or face, unless you have a neck dissection.

Sometimes the surgeon removes the cancer, using a laser (a high-power beam of light). The light may be attached to a microscope, so the surgeon can see the tissue in detail when they are operating. This is called transoral laser surgery and might be used for smaller cancers on the lip, mouth and throat.

Sometimes the surgeon might use robotic instruments to perform the surgery. This is called transoral robotic surgery. It may be used to treat smaller cancers on the tonsils, tongue base or throat.

Endoscopic surgery

The surgeon may use an endoscope to remove small tumours in the nose or sinuses through the mouth or nose. An endoscope is a thin, flexible tube with a light and a camera at the end.

This type of surgery does not leave any scars on the face or neck.

Open surgery

This means the surgeon removes the tumour by making a cut (incision) or an opening in the skin to do the operation. You will have a scar afterwards although this usually fades over time.

You may have open surgery:

  • if the cancer is bigger
  • if the cancer is at the back of the mouth or in the throat.

If the cancer is in or near the voice box (larynx), the surgeon may need to remove some or all of the voice box. This is known as partial or total laryngectomy. The surgery will affect your speech.

Removing part or all the tongue (glossectomy)

If the cancer is large and started on the front part of the tongue, you may need an operation to remove part or all of the tongue. This is called a partial glossectomy or total glossectomy.

If you have some or all of the tongue removed, it will change the way you speak and swallow. A speech and language therapist (SLT) will help you prepare for your operation and cope with any changes to your speech or how you swallow.

Neck dissection (removing neck lymph nodes)

A neck dissection is an operation to remove some or all of the lymph nodes in one or both sides of the neck.

You may have this operation if tests show the cancer has spread to the lymph nodes. It may also be done if the cancer is large, even if there are no signs of cancer in the lymph nodes. This is because when the cancer is large, there may be small amounts of cancer in the lymph nodes that do not show up on scans or in other tests.

Your cancer specialist assesses the risk of the cancer being in lymph nodes in the neck. This helps them decide whether you need to have a neck dissection. Your risk depends on the type of head and neck cancer you have, the size of the tumour and where it is.

You may have a neck dissection:

  • at the same time as the operation to remove the cancer
  • before having radiotherapy or chemoradiation as your main treatment
  • if the cancer has come back (recurred) in the nodes after treatment.

After a neck dissection, the nerve that helps move the lower lip can sometimes be affected. This can cause weakness on one side of the mouth. It may mean your smile is a bit crooked (asymmetrical) for a while, but this usually returns to normal after a few months.

The nerve that helps with shoulder movement may also be affected. This can cause shoulder stiffness. A physiotherapist can give you exercises to help with this.

Other nerves may also be affected. Your surgeon can explain more about the possible effects after having a neck dissection.

Reconstructive surgery

If the cancer is bigger or in a difficult position your surgery may be more complicated. This may involve removing tissue that is used for speech or swallowing. It might also affect your appearance.

If this is the case, you may have reconstructive surgery as part of the operation. This is when the surgeon takes tissue from another part of the body, such as the forearm, thigh or chest. They use it to replace tissue taken from the head and neck. This is known as a flap.

If the cancer is in the jawbone, the surgeon needs to remove the affected bone, as well as the tumour. They may use bone from another part of the body (usually the lower leg) to replace the missing jawbone. This is known as a bone flap. Your doctor and specialist nurse can give you specific information about this type of operation. You can usually move your jaw again as soon as the operation is over.

Before you have surgery that is likely to change your appearance, it may help to talk to someone who has had a similar operation. Your surgeon or specialist nurse may be able to put you in touch with people. They can talk to you about how the surgery has affected them, and how they have coped. You may also like to join our Online Community.

We have more information about changes to your appearance (body image).

Prosthesis (artificial replacement)

Sometimes, the surgeon may need to remove bones from the face, such as the cheekbone or palate, to remove all of the cancer. Depending on the extent of the operation, they may offer you an artificial replacement called a prosthesis (false part). This is a specially designed, soft, plastic replacement for the part of the face that has been removed.

If you are likely to need a prosthesis, your doctor and specialist nurse will discuss this with you before your operation. You will also talk to a prosthetics technician, who will be involved in designing and making your prosthesis.

The most common prosthesis is an obturator. This is a denture with an extension that is used to cover any gaps in the roof of the mouth. It helps with speech and eating. If you have an obturator fitted during the operation, you may need further appointments with a specialist dentist. This is to make sure the obturator fits well as your mouth heals.

After the operation

Most operations are done under a general anaesthetic. Some people have surgery as a day patient, but surgery often involves a stay in hospital. This may be for several days or up to a few weeks. How long you stay depends on the type of surgery you have and whether or not you have reconstructive surgery.

After your operation, you will be encouraged to start moving around as soon as possible. This is an important part of your recovery. If you have to stay in bed, it is important to do regular leg movements and deep-breathing exercises. A physiotherapist will explain these to you.

If you have had a bigger operation, you may spend some time in intensive care immediately after the operation. This is a ward where you have one-to-one nursing care for as long as necessary to help you recover.

After the operation, it is likely that you will wake up with a number of drips, drains and tubes attached to you. These are gradually removed as you recover.

Drips

Operations to the mouth and throat area usually cause quite a lot of swelling. This can make eating and drinking uncomfortable for a time. Because of this, you will probably wake up from the operation with a tube going into a vein in your arm or neck (an intravenous drip). The nurses will give you fluids through this tube for a few days. They remove the drip when you are able to drink fluids again.

Drains and dressings

Depending on the extent of your surgery, you may have 1 or 2 thin, plastic drainage tubes coming from the operation area. The tubes have bottles attached to them to collect fluid from the wound. This helps the wound to heal. Drains usually stay in place for 2 to 7 days.

If you have had reconstructive surgery using tissue taken from another part of your body, you may also have stitches, a drain and a dressing on this area.

When you go home, a district nurse can check and dress your wound and drain (if it is still in) if necessary. Or you may be asked to go back to the hospital every few days to have it checked. If you do not have dissolvable stitches, you usually have your stitches or staples removed about 7 days after your operation.

Feeding tube

You may not be able to eat for a short time while your tissue heals. This means you may have to get the food and nutrition you need through a feeding tube that goes into your stomach. This may be put in before or during the operation, or if you are going to have radiotherapy after your surgery.

If you need a feeding tube, your cancer specialist will talk to you about this before your operation. Your dietitian and speech and language therapist (SLT) will also talk to you and provide support afterwards. When you can eat and swallow safely, the feeding tube is removed. You may have a swallowing assessment, once your mouth and throat have healed, to check whether you have any swallowing difficulties.

If you go home with a feeding tube, your dietitian , SLT or nurse in the hospital can teach you or your family members or friends, how to use and look after it safely.

Passing urine

You may have a small tube (catheter) to drain pee (urine) from your bladder into a collecting bag. This stops you having to get up to pee (pass urine). It also helps the doctors monitor how well your kidneys are working. It is usually removed after a couple of days.

Temporary tracheostomy tube

Sometimes surgery to the mouth or throat can cause temporary swelling around the throat. This can narrow the airway and make it difficult for you to breathe. If the type of surgery you are having is likely to cause this problem, the surgeon creates a small opening into the windpipe for you to breathe through. This is called a tracheostomy or stoma.

Preparing to go home

Before you leave hospital, you will be given an appointment for a check-up or to plan further treatment, such as radiotherapy. You will also be given appointments if you need to see any other members of the team, such as your SLT, specialist nurse or dietitian.

If it is needed, the ward nurses can arrange for district nurses to visit you at home and look at any wounds and dressings.

We have more information about recovering after surgery for head and neck cancer.

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