Surgery for Oral Cavity and Oropharyngeal Cancer

Several types of operations can be used to treat oral cavity and oropharyngeal cancers. Depending on where the cancer is and its stage, different operations may be used to remove the cancer. Surgery is often the first treatment used for these cancers. It's most commonly used for early stage cancers, those that are small and haven't spread.

After cancer is removed, reconstructive surgery can be done to help restore the appearance and function of the areas affected by the cancer or cancer treatment.

Tumor resection

In a tumor resection, the entire tumor and a margin (edge) of normal-looking tissue around it is removed (resected). The margin of normal tissue is taken out to reduce the chance of any cancer cells being left behind.

The main (primary) tumor is removed using a method based on its size and location. For example, if a tumor is in the front of the mouth, it might be relatively easy to remove it through the mouth. But a larger tumor (especially when it has grown into the oropharynx) may need to be removed through an incision (cut) in the neck or by cutting the jaw bone with a special saw to get to the tumor. (This is called a mandibulotomy.)

Based on the location and size of the tumor, one of the operations listed here may be needed to remove it:

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. 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. Slices are removed and examined 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. It requires a surgeon trained in the technique and may take more time than a standard tumor resection.

Glossectomy (removal of the tongue)

Glossectomy may be needed to treat cancer of the tongue. For smaller cancers, only part of the tongue (less then 1/3) may need to be removed (partial glossectomy). For larger cancers, the entire tongue may need to be removed (total glossectomy).

Mandibulectomy (removal of the jaw bone)

For a mandibulectomy (or mandibular resection), the surgeon removes all or part of the jaw bone (mandible). This operation may be needed if the tumor has grown into the jaw bone. If a tumor near the jaw is hard to move when the doctor examines it, it often means that the cancer has grown into the jaw bone.

If the jaw bone looks normal on imaging tests and there's no evidence the cancer has spread there, the bone may not need to be cut all the way through. In this operation, also known as a partial-thickness mandibular resection or marginal mandibulectomy, the surgeon removes only part or a piece of jaw bone.

If the x-ray shows the tumor has grown into the jaw bone, a large part of the jaw will need to be removed in an operation called a segmental mandibulectomy. The removed piece of the mandible can then be replaced with a piece of bone from another part of the body, such as the fibula (the smaller of the lower leg bones), hip bone, or the shoulder blade. A metal plate or a piece of bone from a deceased donor may also be used to repair the bone.

Maxillectomy

If 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.

Robotic surgery

Increasingly, trans-oral robotic surgery (TORS) is being used to remove cancers of the throat (including the oropharynx).

Because the more standard, open surgeries for throat cancer can cause a number of problems, these cancers have often been treated with chemotherapy combined with radiation (called chemoradiation) over the past decade. But newer robotic surgeries may allow surgeons to completely remove throat cancers with fewer side effects. Patients whose cancers are totally removed with surgery might be able to avoid further treatment with radiation and/or chemotherapy. Since these procedures are newer, it's important to have them done by surgeons (and at treatment centers) experienced in this approach.

Laryngectomy (removal of the voice box)

Very rarely, surgery to remove large tumors of the tongue or oropharynx may 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 there's a high risk of this, the voice box (larynx) may also be removed during the same operation as the one to remove the cancer. Removal of the larynx is called a laryngectomy.

When the voice box is removed, the windpipe is attached to a hole (stoma) made in the skin in the front of the neck. You breathe and cough through this stoma (instead of breathing through the mouth or nose). This is called a tracheostomy or trach (trake).

Losing your voice box will mean that normal speech is no longer possible, but people can learn other ways to speak. See 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. Removing these lymph nodes (and other nearby tissues) is called a neck dissection or lymph node dissection and is done at the same time as the surgery to remove the main tumor. The goal is to remove lymph nodes proven to contain cancer. Sometimes doctors recommend an elective lymph node dissection. This may be done if there's no proof that the cancer has spread to the lymph nodes, but there's a high chance that it has based on tumor size.

In some early stage mouth and lip cancers, a sentinel lymph node biopsy might be done to test the lymph nodes for cancer before removing them. This should only be done by doctors and at treatment centers with a lot of experience in the technique.

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 how much it has 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 are removed, as well as some muscle and nerve tissue.
  • 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 when raising the arm above the head, and weakness of the lower lip. These side effects are caused when nerves that supply these areas are damaged during the operation. After a selective neck dissection, the nerve might only be injured and can heal over time. Nerves heal slowly, but in this case, the weakness of the shoulder and lower lip may go away after a few months. If a 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 therapy can help improve neck and shoulder movement.

Reconstructive surgery

Operations may be needed to help restore the structure of areas affected by more extensive surgeries to remove the cancer.

For small tumors, the narrow edge of normal tissue removed along with the tumor is usually small enough that reconstructive surgery isn't needed. 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 or other area, can be used to repair a small defect. This is called a skin graft.

To repair a larger defect, more tissue may be needed. 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), there are many more options for reconstructing the oral cavity and oropharynx. Tissue from other areas of the body, such as the intestine, arm muscle, abdominal (belly) 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, talk to the surgeon about your options for reconstructive surgery.

Surgery to save or restore body function

Tracheostomy

A tracheostomy or trach is a stoma (hole) made through the skin in the front of the neck and attached to the trachea (windpipe). It's done to help a person breathe.

If a lot of swelling is expected in the airway after the cancer is removed, the doctor may want to do a short-term tracheotomy (using a small plastic tube) to allow the person to breathe more easily until the swelling goes down. It stays in place for a short time, and is then removed (or reversed) when it's no longer needed.

If the cancer is blocking the throat and is too big to remove completely, an opening may be made to connect a lower part of the windpipe to a stoma (hole) in the front of the neck. This is done to bypass the tumor and allow the person to breathe more comfortably. This is called a permanent tracheostomy.

A permanent tracheostomy is also needed after a total laryngectomy.

Feeding tubes

Cancers in the oral cavity and oropharynx may keep you from swallowing enough food to maintain good nutrition. This can make you weak and make it harder to complete treatment. Sometimes the treatment itself can make it hard to eat enough.

A gastrostomy tube (G-tube) is a feeding tube that's put through the skin and muscle of your abdomen (belly) and right into your stomach. Sometimes this tube is placed during an operation, but often it's put in endoscopically. While you are sedated (using drugs to put you in a deep sleep), the doctor puts a long, thin, flexible tube with a camera on the end (an endoscope) down the throat to see inside the stomach. The feeding tube is then guided through the endoscope and to the outside of the body. When the feeding tube is placed through endoscopy, it's called a percutaneous endoscopic gastrostomy, or PEG tube. Once in place, it can be used to put liquid nutrition right into the stomach. As long as they can still swallow normally, people with these tubes can eat normal food, too.

PEGs can be used for as long as needed. Sometimes these tubes are used for a short time to help keep you healthy and fed during treatment. They can be removed when you can eat normally.

If the swallowing problem is likely to be only short-term, another option is to place a nasogastric feeding tube (NG tube). This tube goes in through the nose, down the esophagus, and into the stomach. Again, special liquid nutrients are put in through the tube. Some people dislike having a tube coming out of their nose, and prefer a PEG.

In any case, the patient and family are taught how to use the tube. After you go home, home health nurses usually visit to make sure you are comfortable with tube feedings.

Dental extraction and implants

When radiation treatment is planned, a dental evaluation must be done. Depending on the radiation plan and condition of your teeth, some or even all of the teeth may need to be removed before radiation can start. The teeth may be removed either by the head and neck surgeon or an oral surgeon. If left in and exposed to radiation, teeth that are broken or infected (abscessed) are very likely to cause problems such as infections and areas of necrosis (bone death) in the jaw.

If part of the jaw bone (mandible) is removed and reconstructed with bone from another part of the body, the surgeon might 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.

Surgery risks and side effects

All surgery carries risk, including blood clots, infections, complications from anesthesia, and pneumonia. These risks are generally low but are higher with more complex operations.

If the surgery is not too complex, the main side effect may be some pain afterward, which can be treated with medicines.

Surgery for cancers that are large or hard to reach may be very complicated, in which case side effects may include infection; wound breakdown; problems with eating, breathing, and speaking; or on very rare occasions death during or shortly after the procedure. Surgery also can be disfiguring, especially if bones in the face or jaw need to be removed. The surgeon’s skill is very important in minimizing these side effects, while removing all of the cancer, so it’s important to choose a surgeon with a lot of experience in these types of cancer.

Impact of glossectomy: Most people can still speak if only part of the tongue is removed, but they often notice that their speech isn’t as clear as it once was. The tongue is important in swallowing, so this may also be affected. Speech therapy can often help with these problems.

When the entire tongue is removed, patients lose the ability to speak and swallow. With reconstructive surgery and a good rehabilitation program including speech therapy, some people may regain the ability to swallow and speak well enough to be understood.

Impact of laryngectomy: Laryngectomy, the surgery that removes the voice box, leaves a person without the normal means of speech. There are several ways to restore one’s voice. See Laryngeal and Hypopharyngeal Cancer to find out more about voice restoration.

After a laryngectomy, the person breathes through a stoma (tracheostomy) placed in the front of the lower neck. Having a stoma means that the air you breathe in and out will no longer pass through your nose or mouth, which would normally help moisten, warm, and filter the air (removing dust and other particles). The air reaching the lungs will be dryer and cooler. This can irritate the lining of the breathing tubes and cause thick or crusty mucus to build up.

It's important to learn how to take care of your stoma. You will need to use a humidifier over the stoma as much as possible, especially right after the operation, until the airway lining has a chance to adjust to the drier air now reaching it. You will also need to learn how to suction out and clean your stoma to help keep your airway open. Your doctors, nurses, and other health care professionals can teach you how to care for and protect your stoma, which includes precautions to keep water from entering the windpipe while showering or bathing, as well as keeping small particles out of the windpipe.

Impact of facial bone removal: Some cancers of the head and neck are treated with operations that remove part of the facial bone structure. Because the changes that result are so visible, they can have a major effect on how people view themselves. They can also affect speech and swallowing.

It’s important to talk with your doctor about these changes before the surgery. This can help you prepare for them. You can also get an idea about what options might be available afterward. Recent advances in facial prostheses (man-made replacements) and in reconstructive surgery now give many people a more normal look and clearer speech. These things can be a great help to a person’s self-esteem.

More information about Surgery

For more general information about surgery as a treatment for cancer, see Cancer Surgery.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: March 9, 2018 Last Revised: March 9, 2018

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