Head & Neck Cancer Surgery

Head and neck surgery works in a region where every centimetre does a job: speaking, chewing, swallowing, breathing and the appearance of your face. The operation removes the affected tissue with a margin of healthy tissue around it, addresses the lymph nodes in the neck, and reconstructs what has been taken.

The removal itself may be reached through the open mouth, through a cut in the neck or jaw, or with a laser or a robot passed through the mouth, and the route is chosen by where the area sits and how well it can be seen. A neck dissection, removing the lymph node levels the region drains into, is usually done at the same operation, because these areas spread to the neck early and predictably.

Reconstruction is what makes function possible afterwards. Tissue is moved from elsewhere in your body, most often the forearm, the thigh or the lower leg, with its own artery and vein, and those vessels are joined to vessels in the neck under a microscope. Where bone has been removed from the jaw, bone is replaced with it. Planning this, including any dental work needed before radiotherapy, happens in the weeks before surgery, and a team including a speech and swallowing therapist and a dietitian is involved from the start.

You are admitted a day or more beforehand for dental assessment, nutritional preparation and planning scans. A feeding tube is sometimes placed in advance.

The operation is under a general anaesthetic and is long, commonly four to ten hours and occasionally more where free tissue transfer is involved. Two surgical teams often work at the same time, one removing and one preparing the reconstruction.

A temporary tracheostomy, a breathing tube placed through the front of the neck, is frequently needed to keep the airway safe while the mouth and throat are swollen. It means you cannot speak for a period, and you will be given a writing board or a communication app; it is normally removed within one to two weeks as the swelling settles. Nutrition goes through a tube into the stomach until swallowing is safe. You wake in intensive care, where the reconstructed tissue is checked hourly for the first two days. A stay of seven to fourteen days is usual and longer is common.

Recovery here is measured in months and is as much rehabilitation as healing.

Speech and swallowing therapy starts in hospital and continues for months afterwards. Both improve with structured practice and both plateau at a level that depends on what had to be removed; your therapist will tell you honestly what to expect in your case. Eating is relearned in stages, from thickened fluids through soft food, and many people need a feeding tube for weeks after going home.

The neck and shoulder are stiff after a neck dissection and the exercises you are given prevent a frozen shoulder that is much harder to treat later. Numbness of the ear, neck and the donor site is expected. Most people are not back at work for two to three months, and longer where speech is central to the job.

Radiotherapy, where it is planned, usually starts around six weeks after surgery and brings its own course of dryness, taste change and sore mouth, and dental treatment is completed beforehand for that reason. Smoking and alcohol are stopped, and stopping genuinely changes how the tissue heals and what happens afterwards.