Head and neck cancer can be, as any cancer, a devastating diagnosis for patients. It is particularly difficult as for cancers of the mouth and throat it affects also the way patients look, speak and swallow. Dr. Ducic recognizes that the reconstruction is at least as important as the surgery to take out the cancer as it is important to maintain the quality of life and the patient’s confidence as much as possible. It is for this reason that he is one of the very few surgeons in America that treats a huge volume of head and neck cancer patients but is also board certified in Facial Plastic Surgery. He has described a number of techniques that are used all over the world to help patients maximize their functional and cosmetic outcomes.
The type of reconstruction needed will, of course, depend on the exact defect you have. Dr. Ducic routinely performs all of the procedures that have been shown to be useful in head and neck reconstruction and has trained hundreds of surgeons in advanced techniques. We always will choose the simplest procedure that will get the job done. Sometimes it simply involves moving around the tissues (local flap) around the defect. Larger defects require bringing skin or bone from other parts of the body as grafts. Grafts rely on being able to heal and grow in the wound. If there is a large wound, or the patient has had radiation, or the wound has saliva in it, then tissue is used from outside the head and neck that comes with its own blood supply. This blood supply may still be left attached to where is came from (regional flap such as pectoralis, latissimus, trapezius, supraclavicular, temporalis) or transplanted (free flaps such as radial forearm, ALT, fibula, scapula, rectus, latissimus) and attached to blood vessels in the face and neck.
For small defects it is not necessary but for larger defects, we will often recommend for patients to receive PT (physical therapy), OT (occupational therapy) or speech and swallowing therapy. We utilize a team approach for our cancer patients to maximize the patient outcomes.
Scars and grafts often are discolored and any pedicles (blood supply) may show up as swelling around the face and neck. All of these improve generally over time and final healing is not complete until one year after surgery.
The facial nerve (nerve that moves the face) may be affected by your cancer surgery. Sometimes, we expect it to recover, but occasionally it may be necessary to do reconstruction. We may recommend nerve grafting or a variety of procedures to improve appearance if we do not expect recovery. These may include static procedures around the eye (browlifts (to elevate the brow), gold weight (to help eye close), ectropion (lower lid laxity)) or around the mouth (tensor fascia late slings) or animation ones (nerve transfers (use other nerves in place of the facial nerve), flaps (use muscles to provide movement), or temporalis tendon transfers (to give movement around the corner of the mouth and smile).
There are a myriad of options available to make patients look and feel and function as well as possible. Dr. Ducic trains head and neck surgeons who have completed training in head and neck surgery including facial plastic surgery but desire to learn more of his advanced reconstructive and cosmetic techniques. As a team, we will not be satisfied as long as there are reasonable options that can improve your outcomes.