ENT (Otorhinolaryngology) · MU Sofia

48. Surgical treatment of head and neck carcinomas.

Covers the surgical aims for head and neck carcinomas, then primary tumour resection: indications from conservative to radical surgery, salvage and palliative use, and the access, ablation and reconstruction stages with their complications. It then addresses neck dissection, including therapeutic, elective and staging indications, incision, levels I to VI, selective, modified radical and radical types, and nerve, vascular and late complications. A closing section outlines rehabilitation after treatment.

Inside: 1 section · 1 labelled picture · 13 flashcards · 4 min

Topic 48 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 1 section, about 564 words (4 min of reading), with 13 flashcards.

In this note

  1. Surgical treatment of head and neck carcinomas.

Surgical treatment of head and neck carcinomas.

Surgical treatment of head and neck carcinomas aims to:

Remove the tumor completely

Achieve tumor-free margins

Control regional lymph nodes

Preserve function when possible

The Head (Primary Tumor Resection)

This involves the removal of the main cancer site, which may include the oral cavity, tongue, pharynx, or larynx.

1. Indications

A. Conservative (organ-preserving) surgery- partial laryngectomy, cordectomy

  • Early-Stage Disease (T1–T2): Often the primary treatment for cancers where surgical removal offers high cure rates and preserves function.

B. Radical surgery – tot laryngectomy, tot glossectomy

  • Locally Advanced Disease (T3–T4): Indicated for tumors invading bone (jaw or skull base) or deep muscles, typically followed by radiation or chemotherapy.
  • Salvage Surgery: Performed when cancer persists or recurs after previous radiation or chemoradiation.
  • Palliative Care: To secure an airway or alleviate severe pain/bleeding in incurable cases.

2. Main Stages

  1. 1. Access/Exposure: Utilising Transoral (through the mouth, often with lasers or robots), Endoscopic, or Open approaches (eg, "mandibular swing" where the jaw is temporarily split to reach the throat).
  2. 2. Ablation (Resection): The tumor is removed with a 1.5–2 cm safety margin of healthy tissue. Surgeons often use frozen section analysis mid-operation to confirm the margins are microscopically clear of cancer.
  3. 3. Reconstruction: Defects are closed via:
  • Primary Closure: Stitching the wound directly.
  • Free Flap Transfer: Microvascular surgery where tissue (skin, muscle, or bone) is moved from a donor site (thigh, forearm, or fibula) and reconnected to the neck's blood vessels.

3. Possible Complications

  • Functional: Difficulty swallowing (dysphagia), speech changes (dysphonia), or chronic aspiration of food into the lungs.
  • Wound Issues: Flap failure (death of the transplanted tissue) or orocutaneous fistula (a leak forming between the mouth/throat and the neck skin).
  • Airway: Post-operative swelling requiring a temporary or permanent tracheostomy.

The Neck (Neck Dissection)

This procedure addresses the cervical lymph nodes, which are the primary site for the spread (metastasis) of head and neck cancers. Purpose:

  • Removal of metastatic cervical lymph nodes

1. Indications

  • Therapeutic: When lymph nodes are clinically enlarged or test positive on scans (CT/PET).
  • Elective: Performed in cases where nodes appear normal, but the primary tumor has a high risk (typically >20%) of harbouring microscopic cancer.
  • Staging: To determine the extent of disease and guide post-operative treatment.

2. Main Stages

  1. 1. Incision: Usually, a transverse incision along a natural neck crease for better healing and aesthetics.

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