Head and Neck Cancer Surgery and Reconstruction
What tumour resection, neck dissection and microvascular reconstruction involve, and which questions international patients should ask before an operation.
Curative surgery removes the primary tumour with clear margins, manages the cervical lymph nodes, and reconstructs the resulting defect in the same operation whenever possible. Reconstruction may use a local flap or a microvascular free flap (radial forearm, anterolateral thigh, fibula or jejunum) to restore speech, swallowing, jaw continuity and facial contour.
What are the three parts of a cancer operation?
- Resection: removal of the primary tumour with a planned margin — for oral cavity cancer usually at least 1 cm macroscopically where anatomy allows.
- Neck dissection: removal of lymph node groups, either elective (clinically node-negative but high risk of microscopic spread), sentinel-node based, or therapeutic/modified radical for proven nodal disease.
- Reconstruction and airway: immediate repair with local, pedicled or free tissue, plus temporary or permanent tracheostomy and feeding tube when needed.
What is a free flap?
Tissue transferred from elsewhere in the body with its blood vessels reconnected under a microscope.
| Flap | Typical use |
|---|---|
| Radial forearm free flap | Thin, pliable tissue for tongue, floor of mouth and soft palate defects |
| Anterolateral thigh (ALT) flap | Larger tongue, cheek and pharyngeal defects; can be tubed for the food passage |
| Fibula free flap | Segmental mandible (jaw) reconstruction with bone for dental implants |
| Scapula / iliac crest flap | Complex jaw and midface defects with bone and soft tissue |
| Free jejunal transfer | Reconstruction of the hypopharynx and cervical oesophagus |
| Pectoralis major pedicled flap | A reliable option when free flap is unsuitable or as salvage |
Questions to ask before consenting
- What exactly will be removed, and what function (speech, swallowing, taste, shoulder movement, facial movement, appearance) is expected to change?
- Is a neck dissection planned, and which levels — and why?
- What reconstructive option is planned and what is the donor-site morbidity?
- Will I wake with a tracheostomy or feeding tube, and for how long?
- How are margins assessed, and what happens if a margin is positive?
- Will the pathology report include depth of invasion, perineural invasion and extranodal extension in English?
What does recovery usually involve?
Free-flap patients are monitored closely for the first 24–72 hours because vascular compromise requires urgent return to theatre. Swallowing studies, speech therapy and dietetic support start before oral feeding resumes. Shoulder function after neck dissection, lymphedema, scar contracture and trismus are common long-term issues and benefit from early physiotherapy.
Ask for the operative note, pathology report, flap details, and a discharge medication and rehabilitation plan in English. These documents determine whether adjuvant radiotherapy can be planned correctly after you return home.
Frequently asked questions
What is the difference between a neck dissection and a lymph node biopsy?
A sentinel node biopsy removes one or two first-draining nodes to check for microscopic spread. A neck dissection removes an entire anatomical group of nodes (levels I–V, or a selective subset) either therapeutically for known metastases or electively because the risk of occult spread is high.
Are free flaps safe in older patients or those with diabetes?
Chronological age alone is not a contraindication. Fitness is assessed by anaesthetic risk, vascular quality, nutritional status, prior radiotherapy and donor-site vessels. Well-optimised older patients routinely undergo free-flap reconstruction.
Will I need a tracheostomy?
It depends on the site and extent. Major tongue, floor-of-mouth, laryngopharyngeal and bilateral neck surgery often requires a temporary tracheostomy to protect the airway while swelling resolves; total laryngectomy creates a permanent stoma.
Can reconstructive surgery be done later?
Immediate reconstruction is usually preferable because it avoids scarred, irradiated tissue and a second major admission. Delayed reconstruction is possible for selected patients, but is technically harder and prolongs functional recovery.
Sources for this guide
Applying this to your own case?
Start with a remote review of your records, then compare the written plan with the options you have at home.
Records checklist How to compare plansMedical disclaimer: This knowledge base is general information for people researching head and neck tumours, not a diagnosis or treatment plan. It does not replace an examination by a qualified physician. Survival figures are population averages, not predictions for an individual. Treatment and cost estimates for China are illustrative only and must be confirmed in writing after your records have been reviewed. If you have a symptom lasting more than two to three weeks, see a doctor promptly.