Complex Head & Neck Reconstructive Surgery

The removal of tumors, affected tissues, and other structures sometimes necessary to effectively treat head and neck cancers can result in issues with function and appearance. The purpose of complex head and neck reconstructive surgery is to rebuild defects in the neck and/or face resulting from initial surgery to remove harmful tissues.

• Many of the procedures that may be performed by an ear, nose, and throat specialist involve the use of tissues, muscle, skin, and blood vessels from other parts of the body.
• With most operations, grafts or flaps are transferred from the donation site to the affected area.

Head and neck reconstruction surgery is typically performed to address aesthetic and functional abnormalities of the face, skull, jaws, and ears. In some instances, surgery is done when wounds do not heal as expected or when there are existing defects. Reconstruction surgery in head and neck areas may also be recommended following treatment for malignant or benign tumors affecting:

• The mouth and adjacent oral cavity
• Salivary glands
• Tongue
• Larynx or pharynx
• The jaw and sinuses

With a skin graft, a patch of healthy skin is transferred from another location on the body, usually an area where there’s excess skin tissue. The transferred tissue is used to cover the large wound or area where there’s missing or damaged skin. There are different types of skin grafts that may be done. A split-thickness graft involves layers of skin close to the surface. Typically used for small facial defects, a full-thickness graft is done with all layers of skin. Usually recommended for wounds/defects with a complex shape, a composite skin graft includes fat tissues and underlying cartilage.

With this type of reconstructive surgery, tissue and blood vessels are transferred from one part of the body to the affected part of the head or neck. The “flaps” used can be either local or regional. A local flap comes from skin that’s close to the defect or wound. A regional flap is transferred with a blood vessel attached from the original site.

Also called free flap surgery, microvascular reconstruction involves the movement of tissue from parts of the body away from the transfer site. Microvascular surgical techniques are used to reconnect the blood supply at the new site. If the skull base needs to be reconstructed, abdominal or back muscles may be used as part of a microvascular procedure known as a free muscle transfer.

For upper jaw or mid-face reconstruction, part of a rib or calf bone (fibula) is used. Defects in the tongue, head, neck or neck skin, nasal lining, or pharynx may be corrected with tissues from a forearm or thigh when a free skin and fat transfer is performed. In some cases, a temporary tracheotomy is needed to maintain breathing capabilities as reconstruction is performed.

Because of the nature of complex head and neck reconstructive surgery, it’s often done after a patient has healed from the initial surgery that was done to remove the problem growth when possible. In some situations, reconstruction surgery may be broken down into a series of smaller procedures. Additional cosmetic procedures, including some that may be optional, might also be done. The goal with this type of surgery is to restore function, appearance, and personal comfort.