Head and neck cancers tend to be serious conditions which are treated in a Multi Disciplinary Team. A/Prof Damian Marucci is a member of the Head and Neck Cancer MDT at St George Public Hospital. This MDT involves Sydney head and neck surgeons, plastic surgeons, maxillofacial surgeons, radiation oncologists and oncologists. Patients are seen and assessed by the team and then a treatment plan is tailored for the individual patient. Some patients required surgery, some require chemo- and radio- therapy and other patients require all three.

Understanding Head and Neck Cancers

The most common head and neck cancers seen in the MDT are Squamous Cell Cancers (SCC). These are frequently related to activities such as smoking, alcohol use or wearing dentures. Some SCC are related to certain viruses. There are other rare types of cancer that can affect the oral cavity and tissue of the face and skull which are also treated by specialists in the Head and Neck MDT.

Surgery to remove head and neck cancers often requires the removal of glands in the face or neck, as these are the places where the cancer tends to spread. The amount of surgery required will depend on the size, depth and location of the head and neck cancer. The head and neck surgeons who remove the cancers are careful to remove enough tissue to treat the disease and leave behind as much as possible to minimise the impact of the surgery on appearance and function.

Head and Neck Reconstructive Surgery

Head and neck reconstructive surgery depends completely on what has been removed by the Sydney head and neck surgeon in treating the cancer. The goal of the reconstructive surgeon is to replace what has been removed to restore facial appearance and function. This reconstruction almost always involves moving tissues from other parts of the body into the head and neck area.

Head and neck reconstruction aims to replace “like with like.” If bone is removed, Dr. Marucci aims to replace it with bone. If skin is removed, he will replace that with skin. Often the best ways to do this is using reconstructive microsurgery. All tissue in the body has an artery taking blood to it and a vein taking blood away from it. The idea of reconstructive microsurgery is to isolate tissue — whether that be skin, fat, muscle, bone or a combination of these — on the specific artery and vein keeping it alive, dividing the blood vessels, moving the tissue into the head and neck area and then joining the artery and vein to arteries and veins in the neck. The tissue which has been moved (the “flap” of tissue) now has its own blood supply in the head and neck region. The area where the flap of tissue has come from (the “donor site”) is specially chosen as an area which is “expendable” or, at least, results in minimal deformity or disability to the patient. The nature and type of flap surgery is determined by the reconstructive requirements of the case.

Head and neck cancer procedures are major undertakings. The surgeries can take many hours and multiple specialists are involved both on the day of the procedure and during the recovery afterwards. Patients may go to the intensive care unit in the days after the surgery.

In terms of the reconstruction, the effect of the surgery will depend on which structures and being replaced. For example, if the cancer means that a segment of the jawbone needs to be removed, the reconstruction will usually involve moving bone from the lower leg or hip to reconstruct the area. If only skin and soft tissue is required, tissue from the front of the wrist or side of the leg may be used.

There are some specialised structures in the head and neck which are difficult to reconstruct. The tongue, for example, is a common site of head and neck cancer. The tongue is basically a delicate muscle covered with specialised taste buds. We cannot reconstruct the tongue so that a patient has normal taste and movement. As a result, tongue reconstruction surgery may result in permanent changes in speech, swallowing and taste.

 Learn More about Head and Neck Reconstruction in Sydney

For more information about head and neck reconstructive surgery, A/Prof Damian Marucci invites you to call or email our Kogarah or Miranda offices today.