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NYU Langone surgeons often perform reconstructive surgery to restore the soft tissue, bone, and teeth that may need to be removed during surgery for oral cancer. Reconstruction is done at the same time the cancer is removed.
Reconstruction may involve transferring tissue or bone from another area of the body to the oral cavity. Doctors may transfer this tissue using microvascular surgery, in which they cut and sew together small blood vessels under a microscope. This helps restore blood flow to the tissue in the area of repair.
Microvascular reconstructive surgery is often used to rebuild structures that help with the mouth’s functions, such as chewing and swallowing food and speaking. Dental implants may also be necessary, if teeth are removed.
Soft Tissue Reconstruction
Surgeons may use a variety of approaches to reconstruct soft tissue, including skin grafts, local or free flaps, or nerve grafts.
Reconstructive surgeons can repair soft tissue in parts of the tongue, the lining of the mouth, and the lips using a portion of skin called a graft. Grafts may be taken from the abdomen or leg and used to repair small portions of the mucosa, which is the lining of the mouth.
Sometimes, larger areas of soft tissue that are removed from the oral cavity can be replaced with a portion of healthy tissue called a flap. This tissue may consist of skin, muscle, and fat.
Flaps can often be moved from nearby areas, such as the scalp, cheek, forehead, neck, or chest, without disconnecting the blood vessels that “feed” the flap.
Flap tissue may also be taken from a distant part of the body. This tissue is called a free flap. Doctors use microvascular surgery to cut through the attached blood vessels to remove the flap and reattach it at the site of the repair.
Being able to use a free flap from a distant part of the body gives surgeons more options for selecting tissue that best matches the site of repair in the oral cavity. Careful selection of tissue can help to restore function.
For example, doctors may remove forearm skin and underlying soft tissue to replace a missing portion of the tongue to help with speech and swallowing.
Doctors may use nerve grafts—in which they remove a nerve from somewhere in the body where its absence isn’t noticeable—to restore sensation and movement to the tongue and lips. This allows for proper speech and swallowing.
Surgeons at NYU Langone are experts in reconstructing the upper and lower jawbones. Before surgery, specialists use CT scans of the tumor and jaw to create three-dimensional, computer-generated models of the areas to be reconstructed. Surgeons use these models to guide them as they make the incisions needed to remove the cancerous jawbone and construct the new jaw.
To rebuild the jaw, doctors may use a piece of the fibula, a bone from the lower leg. Other bones in the face can also be reconstructed. For example, the hard palate, or roof of the mouth, can be replaced with bone from other parts of the body, such as from the fibula or the scapula, which is also known as the shoulder blade.
Doctors ensure that the procedure does not create a disability in the area from which the bone is taken.
After the jawbone is restored, periodontal surgeons may use dental implants and prosthetic teeth to restore the mouth’s appearance and your ability to chew.
Dental implants are small screws that are placed into the top or bottom jawbone to replace the root of a tooth. The screws are made from titanium, a metal that fuses with the surrounding jawbone over several months. After this process is complete, your surgeon attaches custom-made replacement teeth.
Recovery from Reconstructive Surgery
Recovery time after reconstructive surgery varies. Minor reconstruction, such as when a skin graft is performed, may require only two or three days of recuperation in the hospital. If you need extensive reconstruction, such as the removal and replacement of the jaw or a large portion of soft tissue, you may need to stay in the hospital for up to a week or more.
During this time, NYU Langone doctors monitor your health and ensure you are healing properly.
After surgery, NYU Langone therapists are available to help restore your speech and swallowing abilities. Doctors at Rusk Rehabilitation may prescribe physical therapy to help with balance and walking, for example, if you had a bone from the leg removed.
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