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Head & Neck Cancer Reconstruction

Head and neck cancer reconstruction is a specialised surgical procedure designed to restore function, structure, and aesthetics following the removal of cancerous tumours in the face, jaw, throat, or neck. These procedures help patients regain speech, swallowing ability, breathing function, and facial symmetry, significantly improving quality of life after cancer treatment.

Reconstruction may involve microsurgical tissue transfer (flap reconstruction), bone grafting, skin grafts, or prosthetic rehabilitation, depending on the extent of tissue loss and individual needs.

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Dr Terence Goh

MBBS

MMed

MRCS

FAMS

head and neck head and neck

Indications and Benefits

  • Restoring Facial Structure

    Tumour removal in the face, jaw, or neck can lead to significant tissue loss. Reconstruction restores facial symmetry, soft tissue coverage, and structural integrity to improve both appearance and function.

  • Speech and Swallowing Rehabilitation

    Surgery can help restore oral function for patients who have lost part of the tongue, throat, or jaw, allowing for improved speech, swallowing, and overall communication.

  • Breathing and Airway Restoration

    Tumours affecting the airway or throat may require tracheal or pharyngeal reconstruction to restore breathing stability and maintain airway function.

  • Skin and Soft Tissue Reconstruction

    Patients with large skin defects require flap reconstruction or skin grafting to restore skin integrity, improve wound closure, and enhance facial aesthetics.

  • Jaw and Dental Rehabilitation

    Loss of the jawbone (mandible or maxilla) can affect chewing and speech. Bone grafting or fibula-free flaps help reconstruct the jaw, enabling dental implants or prosthetics for full oral function recovery.

Reconstruction Techniques

Local and Regional Flap Reconstruction

Local and regional flap reconstruction uses nearby muscle, skin, or tissue to close defects and restore form and function in affected areas. These flaps retain their own blood supply, making them reliable for smaller reconstructions. Commonly used flaps include:

  • Pectoralis Major Flap (chest): Provides soft tissue coverage for the throat and neck.
  • Latissimus Dorsi Flap (back): Used for larger reconstructions requiring more muscle and skin.
  • Anterolateral Thigh (ALT) Flap (outer thigh): Suitable for extensive soft tissue defects.
  • Radial Forearm Flap (forearm): Ideal for tongue and throat reconstruction due to its thin, pliable tissue.
  • Fibula Free Flap (calf): Used for jawbone reconstruction, providing bone structure for function and aesthetics.
Free Flap (Microsurgical) Reconstruction

Microsurgical free flaps involve transferring tissue, fat, and blood vessels from another part of the body and reconnecting them to the head and neck using microsurgery. These flaps provide a more natural look and function while ensuring a good blood supply for healing.

  • Radial Forearm Flap: Ideal for tongue and throat reconstruction, providing thin, flexible tissue.
  • Fibula Free Flap: Used for jawbone reconstruction, restoring bone structure for function and aesthetics.
  • Anterolateral Thigh (ALT) Flap: Preferred for larger soft tissue defects, often used for cheek or pharynx reconstruction.
Bone Grafting and Jaw Reconstruction

Bone grafting is necessary for patients who have lost part of the jawbone (mandible or maxilla) due to tumour removal. Bone grafts or fibula-free flaps help restore jaw function, allowing for chewing, speaking, and future dental implants.

Skin Grafting and Prosthetic Reconstruction

For patients with extensive skin loss, skin grafts restore skin coverage in affected areas. Prosthetic reconstruction is an option for patients who cannot undergo surgical reconstruction, including nasal, ear, or jaw prostheses to restore facial features.

Preparing for the Procedure

Consultation and Planning

A thorough consultation evaluates the extent of tissue loss, functional needs, and the most suitable reconstructive approach. The surgeon assesses whether bone, nerve, or soft tissue reconstruction is required, along with speech, swallowing, and breathing considerations. For more complex cases, staged reconstruction may be planned to ensure optimal function and aesthetic restoration over time.

Pre-Surgical Guidelines

To optimise healing and reduce complications, blood-thinning medications such as aspirin, ibuprofen, and certain supplements should be avoided for at least two weeks before surgery. Smoking should be stopped at least four weeks prior, as it can impair circulation and slow healing. Patients requiring feeding tube adjustments before surgery should follow specific dietary recommendations to ensure proper nutrition and recovery support.

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Image CTA – head neck cancer reconstruction – M

Step-by-Step Procedure

1. Anaesthesia Administration

Surgery is performed under general anaesthesia, ensuring the patient remains comfortable and pain-free throughout the procedure. The type of anaesthesia used depends on the complexity and duration of the reconstruction, with longer procedures, such as microsurgical flap transfers, requiring extended anaesthetic management.

2. Tissue Transfer and Bone Reconstruction

Flap reconstruction involves transferring muscle, skin, or fat from another part of the body to restore missing soft tissue and provide structural support. Microsurgical techniques allow for precise blood vessel reconnection, improving tissue survival and function.

For jaw and facial reconstruction, bone grafting or fibula-free flaps are commonly used to rebuild the jawbone, restoring both function and appearance. This is particularly necessary for patients needing dental rehabilitation or improved chewing and speaking ability.

3. Functional Restoration

Nerve repair procedures may be performed to restore facial movement and sensation, helping improve expressions and symmetry. In cases where tumours affect breathing or swallowing, a tracheostomy or feeding tube adjustment may be required to ensure adequate airway support and nutrition during recovery.

4. Incision Closure and Healing Support

Surgical incisions are carefully closed with sutures, ensuring proper wound healing and minimal scarring. Depending on the extent of the procedure, drains or compression dressings may be placed to manage swelling, prevent fluid accumulation, and support healing tissues. Patients are monitored closely in the post-operative period to assess wound healing, flap viability, and overall recovery progress.

Post-Procedure Care and Recovery

Immediate Care

After waking from anaesthesia, patients are closely monitored in a high-dependency unit to ensure stability and flap viability. They may have monitoring lines, drainage tubes, a feeding tube, and in some cases, a tracheostomy tube, which may temporarily affect speech. Pain relief is provided, and as recovery progresses, tubes are gradually removed. Patients are encouraged to mobilise early to prevent complications such as blood clots or infections.

Recovery Timeline

Swelling and tightness ease within two weeks as healing begins, though flap reconstruction patients may have donor site soreness. Hospital stays last 1.5 to 2 weeks, with light activities resuming in four to six weeks, while strenuous movements should be avoided. Speech and swallowing therapy may start early, and over three to six months, scars fade, tissue settles, and function improves, especially for jaw and airway reconstructions.

Aftercare Recommendations

Avoid strenuous activities and minimise pressure on reconstructed areas for at least four to six weeks. Proper wound care is necessary to prevent infection, and surgical sites should be kept clean, following post-surgical hygiene guidelines.

Compression garments or supportive dressings may help reduce swelling and improve healing. Regular follow-up appointments are needed to monitor progress. A personalised rehabilitation plan may include speech therapy, swallowing exercises, or physiotherapy, depending on the reconstruction type.

Potential Risks and Complications

While head and neck reconstruction is effective, risks include flap failure due to inadequate blood supply, highest within the first 1–3 days post-surgery, potentially requiring emergency intervention. Infection or salivary leaks from wound exposure to bacteria may need further treatment. Poor wound healing can lead to wound breakdown, sometimes requiring surgery. Other risks include nerve damage, speech or swallowing difficulties, scarring, and the possibility of revision surgery.

Frequently Asked Questions (FAQ)

How long does head and neck reconstruction take?

The surgery duration varies depending on the complexity of the reconstruction. Flap-based reconstructions can take 6–12 hours, as they involve microsurgical tissue transfer and blood vessel reconnection. Simpler procedures, such as skin grafting or local flap repairs, typically take 3–6 hours.

Will I need multiple surgeries for reconstruction?

Some patients require staged reconstruction, involving multiple procedures over time. Additional surgeries may be needed to refine function, improve aesthetics, manage scarring, or adjust flap contours for better long-term results.

Does radiation affect reconstruction results?

Yes, previous radiation therapy can significantly impact healing and tissue quality, increasing the risk of poor wound healing, flap failure, and fibrosis (tissue hardening). Flap-based reconstruction is preferred over implants or skin grafts, as it provides better blood supply and is more resilient in irradiated areas.

Can nerve function be restored after reconstruction?

Some nerve regeneration may occur, but full restoration of sensation or movement is not always possible. In some cases, nerve grafting or muscle transfers may help improve facial movement or sensation over time. Rehabilitation therapies can also support functional recovery.

Will my speech be affected after head and neck reconstruction?

Depending on the location of reconstruction, speech may be temporarily or permanently affected. Patients undergoing tongue, throat, or jaw reconstruction may experience difficulty articulating words, requiring speech therapy to regain function.

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Dr Terence Goh

Choosing to combine the intricate skills of microsurgery with aesthetic surgery, Dr Goh specialises in gynaecomastia, surgery of the Asian face, particularly Asian eyelid surgery and rhinoplasty.

Blending the precision of microsurgery with the artistry of aesthetic surgery, Dr Goh has a special interest in gynaecomastia, facial procedures, including ptosis and eyelid surgery, as well as rhinoplasty.

He also offers a full range of body contouring procedures such as mummy makeovers, breast augmentation, liposuction, and body sculpting—designed to help patients feel more confident and comfortable in their own skin.

Beyond aesthetics, Dr Goh remains active in reconstructive microsurgery, with expertise in breast reconstruction, head and neck reconstruction, and lower limb salvage—restoring both form and function where it’s needed most.

  • Bachelor of Medicine, Bachelor of Surgery, National University of Singapore
  • Master of Medicine, National University of Singapore
  • Member of the Royal College of Surgeons
  • Fellow of the Academy of Medicine, Singapore (Plastic Surgery)
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