Several operations are commonly used to treat oral cavity and oropharyngeal cancers. Depending on where the cancer is and its stage, one or more of the following procedures may be used to remove the cancer, and to help restore the appearance and function of the tissues affected by the cancer or its treatment.

Tumor resection

This operation removes (resects) the entire tumor and an area of normal-appearing tissue around it. Removing this normal tissue decreases the chance of leaving any cancer behind. The primary tumor can be removed in several different ways -- through the mouth, for instance, if it is small and easy to reach. Sometimes with a larger tumor, especially when it involves the oropharynx, the cancer is removed through an incision in the neck or by cutting the jaw bone with a saw to provide access to the tumor (mandibulotomy). Surgery is usually the treatment of choice for cancers of the oral cavity.

Mohs micrographic surgery (for some cancers of the lip)

Some cancers of the lip may be removed by Mohs surgery, also known as micrographic surgery. In this method, the tumor is removed in very thin slices. Each slice is looked at right away under the microscope to see if there are cancer cells. The surgeon continues to remove more slices until no cancer cells are seen. This method can reduce the amount of normal tissue removed with the tumor, and limit the change in appearance the surgery causes.

Full or partial mandible (jaw bone) resection

A mandibular resection removes all or part of the jaw bone. This may be needed if the tumor has grown into the jaw bone. If there is limited tumor movement when the doctor examines the area, it is considered a sign that the cancer has grown into the jaw bone. If the jaw bone looks normal on x-ray, and there is no evidence the cancer has spread into the jaw bone, a partial-thickness mandibular resection may be all that is needed. In this operation a piece of jaw bone is removed, but the bone is not cut all the way through. If the x-ray, shows the tumor has grown into the jaw bone, a whole portion of the mandible will need to be removed

Maxillectomy

If a cancer has grown into the hard palate (front part of the roof of the mouth), all or part of the involved bone (maxilla) will need to be removed. This operation is called a maxillectomy or partial maxillectomy. The hole in the roof of the mouth this operation creates can be filled with a special denture called a prosthesis. This is created by a prosthodontist, a dentist with special training.

Laryngectomy (removal of the voice box)

Very rarely, surgery to remove large tumors of the tongue or oropharynx may also require removing tissue that a person needs to swallow normally. As a result, food may enter the windpipe (trachea) and reach the lungs, where it can cause pneumonia. When this is a significant risk, sometimes the voice box (larynx) is removed together with the primary tumor. This operation is called a laryngectomy. When the voice box is removed, the windpipe is attached to a hole (stoma) in the skin of the neck which the patient will breathe through (instead of breathing through the mouth or nose). Losing your voice box does not necessarily mean that you lose the ability to talk. There are several ways to restore your voice. See the American Cancer Society document Laryngeal and Hypopharyngeal Cancer to find out more about voice restoration.

Neck dissection

Cancers of the oral cavity and oropharynx often spread to the lymph nodes in the neck. Depending on the stage and exact location of the cancer, it may be necessary to remove these lymph nodes by an operation called a neck or lymph node dissection. The goal is to remove lymph nodes proven or likely to contain cancer.

There are several types of neck dissection procedures, and they differ in how much tissue is removed from the neck. The amount of tissue removed depends on the primary cancer's size and extent of spread to lymph nodes.

• In a partial or selective neck dissection only a few lymph nodes are removed.

• For a modified radical neck dissection most lymph nodes on one side of the neck between the jaw bone and collarbone, as well as some muscle and nerve tissue are removed.

• In a radical neck dissection nearly all nodes on one side, as well as even more muscles, nerves, and veins are removed.

The most common side effects of any neck dissection are numbness of the ear, weakness in raising the arm above the head, and weakness of the lower lip. These side effects are caused by injury during the operation to certain nerves that supply these areas. After a selective neck dissection, the weakness of the arm and lower lip usually go away after a few months. But if either nerve is removed as part of a radical neck dissection or because of involvement with tumor, the weakness will be permanent. After any neck dissection procedure, physical therapists can teach the patient exercises to improve neck and shoulder movement.

Pedicle or free flap reconstruction

The narrow zone of normal tissue removed along with small tumors usually does not need reconstruction. But removing larger tumors may cause defects in the mouth, throat, or neck that will need to be repaired. Sometimes a thin slice of skin, taken from the thigh, can be used to resurface a small defect. This is called a skin graft.

To repair a larger defect, a piece of muscle with or without skin may be rotated from an area close by, such as the chest (pectoralis major pedicle flap) or upper part of the back (trapezius pedicle flap). Thanks to advances in microvascular surgery (sewing together small blood vessels under a microscope), surgeons have many more options for reconstructing the oral cavity and oropharynx. Tissue from other areas of the body, such as the intestine, arm muscle, abdominal muscle, or lower leg bone, may be used to replace parts of the mouth, throat, or jaw bone. Before you have extensive head and neck surgery, it is a good idea to ask the surgeon about your options for reconstructive surgery.

Tracheostomy

If the cancer is blocking the throat and is too large to remove completely, a hole (tracheostomy) may be opened in the windpipe and in the front of the neck to bypass the tumor and allow the person to breathe more comfortably. If a lot of swelling is expected after the tumor is removed, the doctor may want to do a temporary tracheotomy (incision of the trachea) to allow the person to breathe more easily until the swelling goes down.

Gastrostomy tube

Cancers in the oral cavity and oropharynx may prevent a person from swallowing enough food for adequate nutrition. It is sometimes necessary to place a feeding (gastrostomy) tube through the skin and muscle of the abdomen directly into the stomach. Gastrostomy is a minor surgical procedure. It can be placed by a radiologist, who can put the tube directly into the stomach.

Another way is for a doctor to put the tube into the stomach through the mouth and then it is "snared" by a device that goes into the stomach. Usually this is aided by a doctor who is looking into the stomach through the mouth with a device called a gastroscope. This is known as a percutaneous endoscopic gastrostomy or PEG. Patients are fed special liquid nutrients that are dripped through the tube. As long as they can still swallow normally, patients with these tubes can also eat normal food as well. PEGs can be used to feed a patient indefinitely. Sometimes these tubes are used only temporarily to help keep a patient healthy and fed during treatment. They can be easily removed when the patient can eat normally..

If the swallowing problem is thought to be only short-term, a nasogastric feeding tube (an NG tube) may be placed through the nose, down the esophagus into the stomach. Again, special liquid nutrients are dripped through the tube. Some patients dislike having a tube coming out of their nose, and prefer a PEG.

In either case, the patient and family are taught how to use the tube. After the patient goes home, home health nurses usually visit to make sure that the patient is comfortable with tube feedings.

Dental extraction and implants

When radiation treatment is planned, a dental evaluation is mandatory. Depending on the radiation plan and condition of the patient's teeth, it may be necessary to remove some or even all of the teeth before radiation can be given. The teeth may be removed either by the head and neck surgeon or an oral surgeon. If left in, teeth that are broken or infected (abscessed) are very likely to cause major problems (such as serious infections) if exposed to radiation.

When part of the jaw bone is removed and reconstructed with bone from another part of the body, the surgeon may place dental implants (hardware to which prosthetic teeth can be attached) in the bone. This can be done either at the same time the mandible is reconstructed or at a later date.

Last Medical Review: 09/24/2009
Last Revised: 09/24/2009