Head and Neck Surgeries with Plastic Reconstructions
1. Wire Guided Excision
Parotid Surgeries are technically demanding since the nerve that controls all the muscles of the face (facial nerve) passes right through the gland with no clear cleavage planes.
For certain benign conditions like Warthin’s Tumour which commonly arise in the tail of the parotid, just the removal of the affected segment may suffice and it actually prevents the possible temporary weakening of nerve functions.
However, in certain other situations like Pleomorphic Adenoma, the entire superficial part of the gland has to be removed while all the nerve braches have to be meticulously dissected and saved. While in diseases like High Grade Mucoepidermoid Cancers or Adenoid Cystic Tumours, the entire parotid gland (superficial part and deep part) have to be removed.
In certain situations, the part or whole of the nerve may be involved by the tumour and may have to be removed along with the tumour so that no tumour is left behind. In such cases, patients may have weakness or paralysis of certain muscles supplied by those nerve branches.
Thyroid gland sits on the wind pipe. The nerves that control the vocal cords and the glands that control body’s calcium levels are very close to it. It is essential to preserve these nerves and gland during thyroid surgeries. For condition like benign nodules and adenomas, follicular neoplasms removal of one half of thyroid (one lobe and the isthmus) is adequate. For thyroid cancers, however, often the entire gland is removed. In certain select cases, lymph nodes also have to be removed.
After total removal of thyroid gland, life long supplementation of thyroid hormone is necessary.
Oral Cavity Cancers & Cancers of Larynx
These cancers arise because of chewing tobacco, gutkha, pan etc. Any part of the oral cavity can get affected – tongue, inner side of cheek (buccal mucosa), gums (alveolous), palate, tonsils and/or voice box and its surrounding areas.
Surgery for Oral Cavity
For oral cavity cancers that are in front of the tonsils and soft palate, surgery is the best option. The surgery requires removal of the cancer with at least 1cm of normal tissue around it. For a small place, like the oral cavity, such surgery will cause a significant defect.
Filling this defect is very important to retain the structure, function and appearance. Sometimes it is possible to fill up this defect with local tissue. But most of the times it is essential to bring new tissue from outside, such as the head or neck area to fill the defect caused by surgery.
Since the face is the most visible part of body and a part of one’s identity it is absolutely critical to maintain the look and function of the removed part. Hence, whenever needed, the defects are filled with free flaps.
These are tissues harvested from far off body parts such as the patient’s arms or legs. Since all the body parts need blood supply to stay alive these harvested tissues are joined to the blood vessels present in the neck with the help of magnifying loupes or microscopes. This is called microvascular surgery.
At present, free flap is the standard way of reconstruction in a Head or Neck Cancer Surgery.
Surgery for Larynx
In the present era, most larynx cancers are treated by Chemoradiation. However, surgery becomes necessary if the larynx has lost its function i.e when a patient cannot breathe properly, liquids enter his or her wind pipe due to lack of the voice box function.
In such situations the entire voice box has to be removed and patient gets a permanent hole in the neck. Though it appears gruesome, almost all patients adapt to this stoma (hole). Most of the times we insert a voice prosthesis after removing the voice box. With training, patients can use this voice prosthesis and can produce good quality speech to communicate.