Microvascular reconstructions: Why head and neck cancers require multispecialty treatment
Microvascular reconstruction is a highly complex procedure that involves rebuilding the mouth structure with blood vessels, bone, and soft tissue from other parts of the body, including muscle and skin
Head and neck cancers are malignant tumours that form in or around the mouth, nose, throat, larynx (voice box), salivary glands, and sinuses. They account for roughly one-third of India’s cancer burden. This is primarily because in India, both men and women begin smoking (via cigarettes) and using smokeless tobacco at a young age (gutka, pan). Furthermore, as a result of a lack of awareness and delays in screening and testing, patients present with advanced cases of cancer. These cancers may cause structural abnormalities and functional limitations in many people, depending on the size and location of the cancer.
Cancers of the mouth (oral cancer) are primarily treated surgically. Cancer removal necessitates the removal of some normal mouth tissues. These could be portions of the cheek, the jawbone or the tongue depending on the location of the cancer. If the removal is extensive, the patient is likely to suffer from structural and functional consequences. To ensure reconstructions that give patients a new lease on life, a multidisciplinary treatment approach involving plastic surgeons, dental surgeons, and head and neck oncologists is followed. Speech and swallow therapists play an important role in helping patients redevelop their social and cognitive communication abilities during the rehabilitation period.
Microvascular reconstruction is a highly complex procedure that involves rebuilding the mouth structure with blood vessels, bone, and soft tissue from other parts of the body, including muscle and skin. Flaps of healthy tissue and blood supply are harvested from various locations throughout the body and transferred to the affected area in the head or neck. They are sutured to the blood vessels of the neck using a microscope, allowing the tissue to continue to live.
Microvascular reconstruction techniques are classified into two types:
1. Free skin and free fat transfer: In this, a tissue to be transferred contains only skin and fat and is used to reconstruct tongue and cheek defects that do not require bone removal. Initially, the radial forearm was used to provide cutaneous coverage. The anterolateral thigh flap is becoming more popular due to its consistent vascularity, ease of harvest, and versatility. Skin, skin and fat, fat and fascia, or fascia alone can be safely harvested from this site.
2. A free bone transfer: Since a precise alignment is required, using a bone for reconstruction is technically more difficult. While bone is typically used for mandibular reconstruction following jaw removal due to cancer, advancements in technology allow it to be used for midface and orbitomaxillary reconstruction as well. This allows for the transfer of a large volume of bone, muscle, and skin from patients to rebuild the jawbone and restore chewing and biting function. Teeth can be implanted into this new bone in selected patients, allowing for full dental restoration.
Microvascular reconstruction allows patients with debilitating head and neck cancers to live a relatively normal life. It boosts their self-esteem and ensures they have a fulfilling social life. It allows earning members of the family to return to work. Technology and medicine, as well as inter-speciality teamwork, are critical for patients who require advanced surgery to maintain some semblance of normalcy in their daily lives. While the surgery is extremely advanced, the benefits are undeniable because it improves the quality of life.
The author is Director, Head and Neck Oncology, Cancer Institute, Medanta Hospital, Gurugram. Views are personal.
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