Head and neck surgery at Cambridge Hospital

What is head and neck surgery?

Head and neck surgery covers the upper airway and digestive tract, ears, facial and neck skin, and structures at the front of the neck including the thyroid gland and surrounding glands. It's used to remove growths, whether cancerous or not, and to treat other problems affecting these areas.

What conditions does head and neck surgery treat?

Head and neck surgery can be used for:

• cancer affecting the mouth, throat, voice box, nose, sinuses, or the salivary and thyroid glands
• growths that aren't cancerous, including salivary gland tumours, thyroid nodules or an enlarged thyroid, and salivary stones
• problems present since birth, such as branchial cleft cysts in the neck
• other non-cancerous conditions affecting bone in the skull, jaw or elsewhere nearby

The mouth and tonsils rank among the places these cancers develop most often. Smoking, drinking, and infection with human papilloma virus (HPV) are recognised factors behind them.

What are the aims of head and neck surgery?

The main goal is complete removal of whatever cancer or growth is present, done in a way that protects your looks and keeps your speech, eating and breathing working as normally as circumstances allow.

Whether this route suits your situation rests on several things: what type and stage a cancer is at, exactly where it sits and how large it's grown, your general fitness, and what impact the operation itself might have on things like talking, swallowing or breathing.

Are there different surgical techniques used?

Several approaches exist, matched to what each case needs:

• a cut made directly into the skin to reach bigger growths or ones that are harder to access
• working through the mouth itself with no skin cuts at all, an option for some smaller cancers in that area
• transoral laser microsurgery (TLM), removing tissue with a laser directed via microscope, again through the mouth
• transoral robotic surgery (TORS), where the surgeon guides robotic arms to work with extra precision, also via the mouth
• removing nearby lymph nodes where cancer might have travelled to them, a step known as neck dissection
• rebuilding an area afterwards using tissue or bone taken from a donor site on your own body

What happens before head and neck surgery?

Scans, such as MRI, CT or PET imaging, are typically used beforehand to work out exactly how big the growth is and where it sits, and a small tissue sample may be taken to confirm what type of cancer is present.

A group of specialists, drawing on surgical, oncology, radiology and pathology expertise, generally reviews your case together to agree the best plan. Your surgeon will then sit down with you separately to talk through the upsides, the downsides, and any other options available, before asking you to agree to go ahead.

You'll typically be told to stop eating and drinking for a period beforehand, and compression stockings are often provided to wear around the time of surgery, which help lower the chance of a blood clot forming.

What happens during head and neck surgery?

1. A general anaesthetic sends you to sleep and keeps you free of pain for the whole thing.
2. Depending on where the growth is, your surgeon either opens the skin, or reaches it entirely through the mouth or with an endoscope, leaving nothing visible on the outside.
3. The growth is taken out along with some surrounding tissue, to give the best chance every trace of cancer has gone.
4. Nearby lymph nodes may be removed too, if there’s a chance the disease has spread that far.
5. Where a substantial amount of tissue has come away, rebuilding work can be done in the same operation, using material sourced from elsewhere on your body.
6. Everything is then closed with stitches or staples and covered with dressings.

What does recovery look like?

Right after surgery, staff keep a close eye on your pain relief, watch for signs of infection, and check things like your pulse, temperature and blood pressure are steady. Hospital stays vary hugely depending on how big the operation was and your own health, anywhere from going home the same day to a few weeks, commonly around a month where rebuilding work was involved.

Getting up and moving as soon as you're able forms an important part of bouncing back, and if bed rest is unavoidable for a while, simple leg movements and breathing exercises help guard against clots and chest infections in the meantime. Depending on what was done, physiotherapy input might follow or help from a speech and language specialist if talking or swallowing has been affected.

A follow-up visit is usually booked a few weeks out so your surgeon can check how the wound has healed, with further appointments arranged as needed. Full recovery stretches over weeks or months and moves at a different pace for everyone, so there's real value in not rushing things.

What are the risks and complications?

Possible risks and side effects of head and neck surgery include:

• discomfort lasting days or weeks afterwards
• numbness or altered feeling around the mouth, face, ears or nearby areas, generally settling within months, though permanent where a nerve had to be sacrificed to fully clear the cancer
• temporary or lasting changes to how you speak
• difficulty swallowing
• a jaw that’s harder to open than usual (trismus), typically only for a while
• swelling and altered appearance that eases gradually over several months
• scarring, which tends to soften and fade with time

Where lymph nodes have been taken from the neck specifically, you might also notice a weaker lower lip or stiffness through the shoulder and neck, both of which tend to ease with time and physiotherapy support.