Head and Neck Reconstructive Surgery

Individuals who may have undergone a head and neck cancer surgery, severe trauma or disease, mostly end up having some aspects of their face and neck structures deformed or damaged due to the mode of treatment used, which may include radiation and/or surgery. To fix the ‘damage’ caused, the patients go through head and neck reconstructive procedures with the goal of not only correcting the functional aspect, but the structural as well.

The microsurgical techniques used ensure that there is a substantial improvement on the said deformities. The elements of the defects may involve bone, skin and soft tissues, which may require restoring the deformed or missing aspects with an artificial device. These devices, which are mostly made with silicone, can be magnetic or implanted to ensure that they attach and blend in where they are placed.

During your appointment with the reconstructive surgeon, the area to be treated is evaluated for the custom built artificial to be made. It’s sculpted to ensure that the artificial device blends with the skin tone. A mold is created that forms a pre-tinted silicone and more layers are formed to match the natural skin of the patient. The silicone is trimmed to fit the needs of the patient.

The reconstruction procedure to be done will depend on the injury/damage, its location, the amount and size of skin lost, neck autopsy, the tissues remaining and blood vessels recipient.

Under what circumstances would one need a head and neck reconstruction?

• Injury to the head and neck that is not healing as expected
• A state where bone tissues are injured severely due to radiation therapy thus causing osteoradionecrosis of the mandible
• Cancer surgery that has led to nasal valve collapse
• Nasal passages that are blocked (Nasal obstruction)
• Abnormal link or holes between the oral cavity and nasal passageway (Oronasal fistula)
• Surgery that has caused a contour deformity.
• During speech the soft palate does not close tightly against the back of the throat causing air to come out through the nose. This is called velopharyngeal insufficiency.

Pre-Op Guidelines

Any head and neck reconstructive procedures should be performed by a qualified, and board-certified reconstructive surgeon. Before the procedure, the patient should ensure that she/he takes all the medications recommended by the doctor. The patient is also expected to be on nil by mouth from the previous night until the time of the surgery.

The head and neck reconstructive procedure is usually done by two teams of specialists in cases where head or neck tumors are involved. You will first have the tumor removed in the initial stage by one team of doctors, then in the second stage, the reconstructive procedure to fix the damage caused by the removal of the tumor is done by another set of doctors. Tests such as tumor mapping, biopsy, imaging and cardiac will be done when the tumor is removed.  All these procedures are discussed by the multi-disciplinary team of specialists involved in your treatment from the start.

Techniques Used in Head and Neck Reconstructive Surgery

Various methods are used to reconstruct the head and neck injuries and deformities. These include:

Bone Graft Transfer

Head and neck cancer patients sometimes get part of the jaw removed when undergoing surgery, thus their speech and movement is affected. The patient is evaluated so that a design of the prosthetics (artificial part) can be done before they undergo the jaw removal surgery. The exact bone is cut to match with the mandible cuts.

Titanium screws are implanted in the facial bones during the time that the jaw removal surgery is done. The healing after the procedure takes an average of 2 months, then the patient returns for the attachments to be placed on the screws that were implanted. The prosthetics are placed on the vascular bed so that the blood can flow smoothly. The screwing ensures that the full denture is balanced between the prosthetics and the natural jaw.

Free Fibula and Flap Inset

This is a technique in which skin flap is removed from one part of the body that can function well without the said tissues, then transplanted on the affected area during the reconstruction process, which as a result allows for normal function and blood flow to this area.

For instance, a patient who may have lost part of his or her jaw as a result of cancer surgery, a bone can be taken from the leg, and reshaped into a new jaw. The technique used ensures that there is normal blood flow after the flap has been placed on the jawbone. The flaps can also be reshaped and inserted on orbital cavity, and even check bones in case these areas had been damaged as a result of cancer surgery.

Free Muscle Transfer

During this procedure, muscle is extracted from the muscles on your back called latissimus or from an abdominal muscle to reconstruct the skull vault or the floor of the cranial cavity. The muscle is used for enclosing the nerve system thus enhancing healing of the open wounds in question.

Free Fat and Skin Transfer

In this procedure, tissues, skin and fat are harvested from anterolateral thigh flap to be used in a head and neck reconstruction surgery. This flap enables reconstruction of contour deformities of the head and neck, throat reconstruction (pharyngeal), neck skin and nasal lining reconstruction and mucosalize (the slippery secretion from the lining of the tongue).

First, the surgeon ensures that the patient is able to breath by performing a temporary tracheotomy procedure (an incision done in the windpipe to relieve the airway) and then inserting a feeding tube after the procedure so that the wounds are able to heal without any interference.

Recovery After Face and Neck Reconstructive Surgery

The patient is put under anesthesia from the time of surgery until the next day and can stay in the hospital for up to 10 days after the surgery depending on the extent and severity of the procedure performed. The longer stay in the hospital is for monitoring and assessment of the wound.

Post-Op Guidelines and Recovery

For safe, faster, and optimal recovery after a head and neck reconstructive surgery, the patient should follow all the recommendations made by the reconstructive surgeon, from taking care of the wound, prescribed medications, follow up on the doctors’ appointments, the dos and don’ts, and what to watch out for in cases of emergencies.

Get in Touch

Reconstructive surgery at Kings College Hospital Dubai focuses on the safety and care of every patient in a compassionate environment with state-of-the-art facilities. To book an online or in-person consultation and a detailed evaluation by one of our world class plastic and reconstructive surgeons in Dubai, get in touch using the contact details given, and our patient-care staff will book an appointment for you.