Reconstructive Procedures: Head and Neck Reconstructive Surgery

CAD in head and neck reconstruction involves the use of pre-operative scans, computer programs and 3D printers to create surgical aids and implants that aim to give the patient as close to a perfect reconstruction as possible. It is most used for head and neck defects requiring bony reconstruction. By bringing the surgical planning to the computer, this effectively increases the accuracy of tissue and bony shaping to the millimetre and cuts down operative time due to the printing of precise cutting guides, templates, and implants. An additional benefit is the ability for immediate dental restoration in select cases. Our plastic surgeon works closely with local and international teams in creating these surgical aids and will discuss their use and necessity with you.

Minimally invasive head and neck reconstruction entails the use of small, well camouflaged incisions, commonly intra-orally, along with adjuncts such as the endoscope or surgical robots, to reconstruct hard-to-reach areas of the head and neck whilst minimizing scarring and surgical morbidity. This is performed for select cases where the avoidance of visible cuts in the face or through the facial skeleton is desirable, for example in cases where there has been previous radiotherapy. Dr Adrian is one of the only plastic surgeons in Singapore trained in the use of the surgical robot and will discuss whether this is a feasible option for your reconstruction.

Radiotherapy (RT) is an important adjunctive treatment in many cancers. In the head and neck, RT can be performed before or after surgery, depending on the cancer characteristics. Whilst RT can help eradicate microscopic cancer cells, it can also have a deleterious effect on normal tissue by inducing scarring and fibrosis. This can lead to debilitating symptoms such as neck tightness and pain, and the inability to fully open the jaw (trismus). Using treatments including botulinum toxin and fat transfer, our plastic surgeon can help to mitigate some of the effects of unwanted radiation injury, which can otherwise be a huge barrier to daily function.

In short, head and neck reconstruction does not interfere with cancer surveillance, even in hard-to-see regions. Besides visualization of the suspect area, there are other methods to detect cancer recurrence including clinical palpation and scans such as CT or PET scans.

Head and neck defects often expose vital structures such as vessels, nerves, tendon, and bone. Oftentimes, they also expose the neck structures to salivary leak and potential infection and can be very aesthetically disfiguring. Whilst some head and neck reconstructive procedures can be delayed, it is seldom that the defects can stay prepped for reconstructive beyond the first 24 to 48 hours before definite reconstruction is required.

Yes, you can. Most times, it is not possible to completely restore normality in one surgery. You can have secondary reconstructive procedures months or even years after the first procedure. Your surgeon will assess you and work with you to achieve your expectations using the best available methods. These may involve fat grafting, prosthesis, and/or flap procedures.