Head & Neck
Reconstruction & Rehabilitation
Depending on the type of cancer and treatment you experienced, you may need reconstructive surgery. You are encouraged to consult with a skilled surgeon who is experienced in head and neck reconstruction about the procedures that may help you perform any impaired vital functions as well as options for restoring your appearance, if needed.
Be aware that reconstruction may require more than one procedure, often not yielding immediate results. Certain organizations are dedicated to contributing financially to help head and neck cancer survivors live fully during and after treatment.
One or more of the following procedures may be used.
Dental rehabilitation. This may be recommended if your upper or lower jaw (maxilla or mandible) and teeth are removed. Prosthetic (artificial) teeth can improve appearance and help you eat more normally. This may include dentures or dental implants.
Flap surgery. When treatment involves surgically removing a significant amount of tissue or bone, a “flap” procedure may be used to replace missing tissue.
Local flap surgery closes the wound left from removing the cancer by rotating or moving nearby skin or tissue. In regional flap surgery, tissue with an attached blood supply is rotated or moved onto the site from a site nearby. This could include muscle and skin from your chest (pectoralis major flap) or skin from your shoulder (supraclavicular flap).
In free flap surgery, also called microvascular reconstruction, a specially trained surgeon removes a “flap” of tissue plus its feeding artery and vein from another part of the body. The surgeon uses this tissue to reconstruct areas in the head and neck, creating a new blood supply by sewing the flap’s artery and vein into an artery and vein near the wound. Commonly used areas for free flaps include the forearm, the thigh, the lower leg or the back/shoulder blade.
Gastrostomy tube (G-tube). Some cancers and their treatments can affect the ability to swallow, which may prevent you from getting adequate nutrition. A gastrostomy tube inserted into your stomach through a small incision in your belly acts as a feeding tube, allowing you to receive liquid nutrition.
Prosthetic rehabilitation. A prosthesis is an artificial replacement for part of your face or mouth (ear, eye, nose, hard palate or teeth). A maxillofacial prosthodontist or anaplastologist will design a custom prosthesis specifically for you.
Tracheostomy. A surgeon creates a hole called a tracheostoma, or stoma, in the front of the neck and connects it to the trachea (windpipe). A hollow plastic tube is inserted to create a new airway to breathe through. This is temporary in most patients during treatment until swelling improves. A tracheostomy tube can easily be removed when it is no longer needed, and the hole will heal.
In surgeries such as a laryngectomy (removal of the voice box), the stoma is permanent and irreversible. A laryngectomy tube (lary tube) is a soft, plastic tube placed during surgery to help in the healing process. Once a patient is healed, no tube has to be worn in the stoma.
Feeling Good About Yourself
A healthy self-image can help you move forward with the rest of your life. Ask for referrals to therapists and other specialists. Some of the best advice may come from other head and neck cancer survivors in an online or local support group.
Facial scarring can make you feel insecure. Your external appearance, swelling and scarring will change as you heal and may be further altered by radiation therapy. Some scars will fade over time. Once you heal from treatment, try makeup to help conceal them and even out your skin tone. Some makeup is available with a prescription. Ask your doctor for a recommendation.
You may feel self-conscious if you have difficulties speaking. Speech therapy can help you improve your communication skills and regain confidence.
Adjusting to your stoma
As you adapt to your stoma, you may find it helpful to ask for advice from your medical team and other cancer survivors who have them. The following suggestions may also help.
- Add humidity to the air that is going into your lungs by using saline squirts and a humidifier when you sleep. Dry air can irritate and cause stoma crusting, coughing and difficulty breathing. Your health care team will explain humidification and a heat and moisture exchange system (HME).
- Maintaining personal hygiene is important. When you bathe or shower, use a shower shield, collar, stoma cover or a washcloth to avoid getting water and soap in your stoma. Even the smallest amounts can cause severe coughing and irritation.
- Daily cleaning is necessary. Your body may produce more mucus to compensate, which can plug your stoma. Your health care team will provide detailed care instructions. Keep tissues handy throughout the day for extra mucus that is secreted.
- When you feel the urge to cough, cover your stoma with a tissue to catch any mucus your cough produces. It may feel strange to cough through your stoma, but most people adjust fairly quickly.
- Wear comfortable clothes. Options to disguise your stoma include turtlenecks, scarves, crew neck cotton undershirts and jewelry.
- If you have dentures, it is important to wear them while you learn new ways of speaking. Properly fitted dentures will help your mouth compress air to produce speech that is more easily understood, so wear them except when sleeping.
- Use a stoma cover to keep pollen, dust, pet hair and aerosol sprays from going directly into your lungs.
- Wear medical identification that alerts others you have a stoma.