Head and neck cancers encompass a diverse group of malignancies that affect various regions of the head and neck, including the oral cavity, pharynx, larynx, sinuses, and salivary glands. Surgical intervention plays a pivotal role in the management of these cancers, aiming to eradicate tumors, preserve vital functions, and restore appearance. This comprehensive overview outlines the key aspects of head and neck cancer surgery.
Definition and Scope: Head and neck cancers refer to a range of malignancies occurring in the head and neck region, excluding brain tumors. They commonly originate in the squamous cells lining the mucosal surfaces.
Common Sites: These cancers typically develop in the oral cavity, pharynx (throat), larynx (voice box), sinuses, and salivary glands.
Tumor Localization and Resectability: Surgery is often indicated when tumors are localized and can be completely removed with clear margins.
Functional Preservation: In cases where surgical removal offers the best chance to preserve essential functions such as speech and swallowing, surgery is preferred
Recurrent or Residual Disease: Surgery may be necessary for recurrent tumors or when residual cancer remains after other treatments.
3.1 Transoral Laser Microsurgery (TLM)
Procedure: Utilizes a high-powered laser to excise tumors through the mouth without external incisions.
Applications: Effective for removing tumors from the larynx and oropharynx, aiming to preserve speech and swallowing functions.
Advantages: Minimally invasive with reduced recovery time and fewer complications.
3.2 Transoral Robotic Surgery (TORS)
Procedure: Employs robotic systems to remove tumors through the mouth, providing enhanced precision and access to difficult areas.
Applications: Suitable for select tumors in the throat and base of the tongue.
Advantages: Minimally invasive, potentially reducing the need for extensive open surgeries.
3.3 Neck Dissection
Procedure: Involves the removal of lymph nodes and surrounding tissue in the neck to manage or prevent the spread of cancer.
Types:
Radical Neck Dissection: Removes all lymphatic tissue in defined regions along with certain muscles and nerves.
Modified Radical Neck Dissection: Preserves one or more non-lymphatic structures while removing lymph nodes.
Selective Neck Dissection: Targets specific lymph node groups based on the tumor’s location and spread.
3.4 Glossectomy
Procedure: Surgical removal of part or all of the tongue.
Applications: Indicated for tumors of the tongue.
Considerations: Extent of removal impacts speech and swallowing; often requires reconstructive surgery.
3.5 Laryngectomy
Procedure: Removal of part (partial laryngectomy) or all (total laryngectomy) of the larynx.
Applications: Used for laryngeal cancers not amenable to conservative treatments.
Consequences: Total laryngectomy results in loss of natural voice; necessitates alternative communication methods.
3.6 Pharyngectomy
Procedure: Excision of part or all of the pharynx.
Applications: Treats cancers of the throat.
Reconstruction: Often requires reconstructive techniques to restore swallowing function.
3.7 Mandibulectomy
Procedure: Removal of a portion of the mandible (lower jaw).
Applications: Necessary when cancer invades the jawbone.
Reconstruction: Involves bone grafts or free flap techniques to restore form and function.
3.8 Maxillectomy
Procedure: Removal of part or all of the maxilla (upper jaw).
Applications: Indicated for tumors affecting the hard palate, nasal cavity, or maxillary sinus.
Reconstruction: May involve prosthetic obturators or free tissue transfer.
3.9 Thyroidectomy
Procedure: Surgical removal of part or all of the thyroid gland.
Applications: Treats thyroid cancers and some benign conditions.
Considerations: May require lifelong thyroid hormone replacement therapy.
3.10 Parotidectomy
Procedure: Removal of the parotid gland, the largest salivary gland.
Applications: Indicated for tumors within the parotid gland.
Nerve Preservation: Careful dissection is necessary to preserve the facial nerve
Objective: Restore appearance and function following tumor removal.
Techniques:
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