The aim of surgery is to completely remove the cancer and preserve the functions of the head and neck area, such as breathing, swallowing and talking. If you have surgery, the surgeon will cut out the cancer and a margin of healthy tissue, which is checked by a pathologist to make sure all the cancer cells have been removed. Often some lymph nodes will also be removed.
- Overview
- Removing lymph nodes
- How the surgery is done
- Reconstructive surgery
- How long will I stay in hospital?
- Will I have any side effects?
- Surgery for oral cancer
- Surgery for pharyngeal cancer
- Surgery for laryngeal cancer
- Surgery for nasal and paranasal sinus cancer
- Surgery for salivary gland cancer
- What to expect after surgery
Overview
The types of surgery used for the different head and neck cancers are described in this section. Thinking about having surgery to your head and neck area can be frightening. Talking to your treatment team can help you understand what will happen. You can also ask to see a social worker or psychologist for emotional support before or after the surgery.
For more on this, see Surgery.
Removing lymph nodes
If the cancer has spread to the lymph nodes in your neck, or it is very likely to spread, your surgeon will probably remove some lymph nodes. This operation is called a neck dissection or lymphadenectomy. Your surgeon will tell you if this is needed and explain the procedure.
Most often, lymph nodes are removed from one side of the neck, but sometimes they need to be removed from both sides. A neck dissection may be the only surgery needed, or it may be part of a longer head and neck operation. The surgeon will make a cut under your jaw and sometimes down the side of your neck. You will often have a small tube (drain) in your neck to remove fluids from the wound for a few days after the surgery.
A neck dissection may affect how your shoulder moves and your neck looks after surgery. A physiotherapist can help improve movement and function (see Lymphoedema).
How the surgery is done
Depending on the type of head and neck cancer you have, different surgical methods may be used to remove the cancer. Each method has advantages in particular situations – your doctor will advise which method is most suitable for you.
Your surgical options for head and neck cancers may include:
- endoscopic surgery – the surgeon inserts a rigid instrument with a light and camera through the nose or mouth to see and remove some cancers, particularly cancers from the nose and sinuses
- transoral laser microsurgery (TLM) – a microscope (usually with a laser attached) is used through the mouth to remove cancers, particularly of the larynx and lower throat
- transoral robotic surgery (TORS) – the surgeon uses a 3D telescope and instruments attached to robotic arms to reach the cancer through the mouth; often used for oropharyngeal cancers
- open surgery – the surgeon makes cuts in the skin of the head and neck to remove cancers; used for larger cancers and those in difficult positions. Part of the upper and lower jaw or skull may need to be removed and then replaced or reconstructed.
Minimally invasive surgery such as endoscopic, TLM and TORS may mean less scarring, a shorter hospital stay and faster recovery. However, these types of surgery are not suitable for all cases, and open surgery is often the best option.
Reconstructive surgery
After open surgery, you may need reconstructive surgery to rebuild your tongue, mouth or jaw and help with speech and swallowing, and to improve how the area looks. It is usually part of the operation to remove the cancer, but is sometimes done later.
In reconstructive surgery, a combination of skin, muscle and sometimes bone is used to rebuild the area. This can be taken from another part of the body and is called either a “free flap” or a “regional flap”.
Occasionally synthetic materials such as silicone and titanium are used to re-create bony areas or other structures in the head and neck, such as the palate. This is called a prosthetic.
How long will I stay in hospital?
How long you stay in hospital depends on the type of surgery you have, the area affected, and how well you recover. Surgery to remove some small cancers can often be done as a day procedure. Recovery is usually fast and there are often few long-term side effects.
Surgery for more advanced cancers often affects a larger area, can involve reconstructive surgery and may take all day. You may need care in the intensive care unit before being transferred to a general ward, and side effects may be long term or permanent. Once you return home, nurses may be able to visit to provide follow-up care.
Will I have any side effects?
Most surgeries for head and neck cancer will have some short-term side effects, such as discomfort and a sore throat. Recovery after a larger surgery may be more challenging, especially at first. Learn more about what to expect in the first days after surgery.
Depending on the type of surgery you’ve had, after a period of recovery, you may not have any ongoing issues. However, some people do need to adjust to permanent changes after head and neck surgery.
Long-term side effects can include:
- reduced energy levels
- difficulty eating (e.g. chewing or problems with teeth)
- speech changes
- breathing changes
- change in appearance
- changes to intimacy and your sex life
- vision and hearing changes
- pain, numbness, swelling (lymphoedema) or less movement in the area.
Talk to your treatment team about what side effects you can expect. Tell them if you experience any worrying side effects after surgery. For more information and tips, see Managing side effects.
→ READ MORE: Surgery for oral cancer
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A/Prof Martin Batstone, Oral and Maxillofacial Surgeon and Director of the Maxillofacial Unit, Royal Brisbane and Women’s Hospital, QLD; Polly Baldwin, 13 11 20 Consultant, Cancer Council SA; Martin Boyle, Consumer; Dr Teresa Brown, Assistant Director Dietetics, Royal Brisbane and Women’s Hospital, Honorary Associate Professor, University of Queensland, QLD; Dr Hayley Dixon, Head, Clinical Support Dentistry Department, WSLHD Oral Health Services, Public Health Dentistry Specialist, NSW; Head and Neck Cancer Care Nursing Team, Royal Melbourne Hospital, VIC; Rhys Hughes, Senior Speech Pathologist, Peter MacCallum Cancer Centre, VIC; Dr Annette Lim, Medical Oncologist and Clinician Researcher – Head and Neck and Non-melanoma Skin Cancer, Peter MacCallum Cancer Centre, VIC; Dr Sweet Ping Ng, Radiation Oncologist, Austin Health, VIC; Deb Pickersgill, Senior Clinical Exercise Physiologist, Queensland Sports Medicine Centre, QLD; John Spurr, Consumer; Kate Woodhead, Physiotherapist, St Vincent’s Health, Melbourne, VIC; A/Prof Sue-Ching Yeoh, Oral Medicine Specialist, University of Sydney, Sydney Oral Medicine, Royal Prince Alfred Hospital, Chris O’Brien Lifehouse, NSW.
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