Reconstructive surgery for mouth and oropharyngeal cancer

Reconstructive surgery repairs an area in the mouth or oropharynx where you might have had surgery to remove a large cancer. It can also reduce the effect that surgery has on:

• bodily functions such as eating, breathing or talking
• the way you look (appearance)

When you might have reconstructive surgery

Your surgeon might need to remove a lot of tissue when you have surgery for mouth and oropharyngeal cancer. Having reconstructive surgery will rebuild these areas. 

You can have reconstruction surgery using:

• tissue from another part of the body (a flap)

• skin from another part of the body (a skin graft)

• bone from another part of the body

Your surgeon might have to make a temporary hole (tracheostomy) in your neck to help you breathe after your surgery. The hole is also called a stoma.

How you have reconstructive surgery

Your doctor will check that you are fit and well enough for a general anaesthetic. They will talk to you about the operation and answer any questions you might have.

Having a general anaesthetic means you won’t be able to eat or drink for several hours beforehand. You usually stop eating at least 6 hours before the procedure. You can usually drink water up to 2 hours beforehand. Your nurse will give you instructions about this.

The anaesthetist inserts a small plastic tube (a cannula) into a vein in your arm or hand. This is used to give you fluids and medications.

Using skin from another part of the body (skin graft)

A skin graft is a thin sheet of skin that your surgeon removes from another part of your body (donor site). They use it to cover the area of skin they remove. The donor site usually comes from somewhere not too obvious, such as your inner thigh.

You have a skin graft during the operation to remove your cancer. The surgeon shaves off the sheet of skin (using a special instrument) or cuts out the donor site. You have a dressing on the donor site.

You don't usually need stitches if your surgeon shaves the donor site. It will heal on its own. You have stitches to repair a donor site that has been cut away.

The skin graft is very delicate while it heals. It's very important that it is not damaged or knocked while healing. Your doctor and nurses will be very careful that your wound doesn't become infected. You may have antibiotics to prevent this.

A disadvantage of skin grafting is sometimes the skin looks different from the surrounding area. For example, it may be a slightly different colour and appear as a dent compared to the surrounding skin.

Using tissue from another part of the body (flap repair)

An operation that moves tissue from one part of the body to another is called a reconstruction free flap or flap repair.  

Your surgeon might take tissue from an area such as the bowel or the muscles in the arms, back or tummy, and use this to replace sections of the mouth or throat. 

Your surgeon may use micro vascular techniques to sew together small blood vessels under a microscope. This is a specialised surgery (by a maxillofacial surgeon). 

After surgery your nurses keep a close eye on the flap. They make sure the new tissue is getting a good blood supply to bring oxygen and nutrients.

Using bone from another part of the body

Sometimes your surgeon may need to remove part of your jawbone. They may replace it using bone taken from the hip, lower leg, arm or shoulder blade. 

They usually use the bone together with some of its blood vessels. Once the bone is in place, they secure it with metal surgical screws. 

Dental implants 

You may need dental implants to replace any teeth removed during surgery. This may be at the same time as your surgery or at a later date. 

After surgery

How long you’ll stay in hospital will depend on the type of surgery you’ve had. You might be in hospital for around 10 days. And recovering at home after several months.

Possible problems after reconstructive surgery

There is a risk of problems or complications after any operation. Many problems are minor but some can be life threatening. Treating them as soon as possible is important.