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Our team of cancer surgeons, reconstructive surgeons, and speech and swallowing rehabilitation therapists work in close collaboration to evaluate each patient for surgery, consider a reconstructive procedure and its potential functional impact, and select the procedure that can reduce the side effects of cancer treatment and restore the patient’s function and appearance. In some cases, we reconstruct a head and neck defect using tissue within the head and neck. However, in situations where the defects are too large or require special components, such as bone, our reconstructive surgeons look to tissue in different body sites and perform microvascular reconstruction. In microvascular reconstructive surgery, we move a composite piece of tissue from another part of the body to the head and neck. The tissue most commonly comes from the arms, legs, or back, and can include bone, skin, fat, and/or muscle. What to move and where to move it depend on the reconstructive needs. Transfer of the tissue to the head and neck allows us to rebuild a jaw, optimize tongue function, or reconstruct the throat. When pieces of tissue are moved, they require their own blood supply for survival in their new location. This is similar to how a transplant works, except we are using a patient’s own body to provide the reconstructive tissue. After the reconstruction is secure in the head and neck, we reconnect the blood vessels that feed the tissue transplant to new blood vessels in the neck. Since these blood vessels are usually 1 to 3 millimeters in diameter, the connections must be done under microscope. We also combine this type of reconstruction with other advanced surgical techniques, such as computer modeling, 3D printing, and customized implant fabrication. Vasu Divi, MD, and Eben Rosenthal, MD, lead our microvascular reconstruction program.
Transoral endoscopic head and neck surgery (eHNS) has become an essential part of the paradigm for multidisciplinary treatment of oropharyngeal carcinoma— especially with the increasing incidence of tumors associated with the human papilloma virus. While radiation therapy given concurrently with chemotherapy is an effective treatment, concerns about late toxicity, especially with regard to swallowing, have led investigators to pursue other options for frontline treatment. Transoral eHNS builds upon years of experience in otolaryngology using specialized endoscopes to visualize, biopsy, and remove tumors of the upper aerodigestive tract. Without external incisions and usually with little or no change in speech, appearance, and swallowing function, such a minimally invasive approach offered obvious benefits to patients. But surgeons were limited by older technologies and could not expand these approaches to provide the kind of comprehensive oncologic resections that could be achieved through “open” head and neck surgery. In 2009, the FDA approved the use of a robotic surgical system for the treatment of benign and T1 and T2 malignant tumors of the head and neck.
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