Why head and neck cancers require multi-specialty treatment

Microvascular reconstruction is a very complex procedure that involves reconstructing the structure of the mouth with blood vessels, bones and soft tissues from other parts of the body, including muscles and skin.

Head and neck cancers are malignant tumors that form in or around the mouth, nose, throat, larynx (voice box), salivary glands and sinuses. They account for about a third of India’s cancer burden. This is mainly because in India both men and women start smoking (via cigarettes) and using smokeless tobacco at a young age (gutka, pan). Additionally, due to a lack of awareness and delays in screening and testing, patients are presenting with advanced cases of cancer. These cancers can cause structural abnormalities and functional limitations in many people, depending on the size and location of the cancer.

Cancers of the mouth (cancer of the mouth) are mainly treated surgically. Removal of cancer requires the removal of some normal oral tissue. These could be parts of the cheek, jaw or tongue depending on where the cancer is. If the ablation is extensive, the patient is likely to suffer from structural and functional sequelae. In order to ensure reconstructions that offer new life to patients, a multidisciplinary treatment approach involving plastic surgeons, dental surgeons and head and neck oncologists is followed. Speech and language therapists play an important role in helping patients re-develop their social and cognitive communication skills during the rehabilitation period.

Microvascular reconstruction is a very complex procedure that involves reconstructing the structure of the mouth with blood vessels, bones and soft tissues from other parts of the body, including muscles and skin. Shreds of healthy tissue and blood are taken from various places in the body and transferred to the affected area of ​​the head or neck. They are sutured to blood vessels in the neck using a microscope, allowing the tissue to continue to live.

Microvascular reconstruction techniques are classified into two types:

1. Free skin and free fat transfer: In this, a transfer tissue contains only skin and fat and is used to reconstruct tongue and cheek defects that do not require bone removal. Initially, the radial forearm was used to provide skin coverage. The anterolateral thigh flap is increasingly popular due to its consistent vascularization, ease of harvesting, and versatility. Skin, skin and fat, fat and fascia, or fascia alone can be safely harvested from this site.

2. A free bone transfer: Since precise alignment is required, using bone for reconstruction is technically more difficult. Although the bone is typically used for mandibular reconstruction after removal of the jawbone due to cancer, advances in technology allow it to be used for midface and orbitomaxillary reconstruction as well. This allows the transfer of a large volume of bone, muscle and skin from patients to reconstruct the jawbone and restore chewing and biting function. Teeth can be implanted into this new bone in selected patients, allowing full dental restoration.

Microvascular reconstruction allows patients with debilitating head and neck cancers to lead relatively normal lives. This boosts their self-esteem and ensures a fulfilling social life. It allows family members who win to return to work. Technology and medicine, as well as interspecialty teamwork, are essential for patients who need advanced surgery to maintain some semblance of normalcy in their daily lives. Although the surgery is extremely advanced, the benefits are undeniable as it improves the quality of life.

The author is Director, Head and Neck Oncology, Cancer Institute, Medanta Hospital, Gurugram. Views are personal.

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