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Surgery to remove the cancer

Many of the operations to remove cancer of the mouth and oropharynx are major surgery. Some will cause changes to the way you look, eat, speak and cope with life. The living with mouth and oropharyngeal cancer section has information about how to cope with any changes that surgery can bring.

Depending on where your cancer is, surgery to remove the cancer can include removing all or part of your jawbone, your tongue or larynx (voice box), or all or part of the bones in the roof of your mouth. Or you might need to have layers of your lips removed. Your surgeon will only remove the tissue necessary to control your cancer.

Removing lymph nodes in your neck

Your surgeon may suggest removing the lymph nodes closest to your cancer. If your cancer has already spread to lymph nodes in your neck, then your surgeon is likely to remove all the nodes on one or both sides of your neck. They may also remove other structures. This is called a neck dissection. It can have long term side effects.

Other operations

Some people need other operations, such as a tracheostomy (an opening made in the front of your neck to allow you to breathe more easily), removal of teeth and replacement with dental implants, or putting in a gastrostomy tube (a tube into your stomach to give you liquid food if you can't swallow). 

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating mouth cancer section.

 

 

About this page

This page covers surgery for both mouth and oropharyngeal cancer but we sometimes just say mouth cancer in the text.

 

How your doctors decide whether to operate

The amount of surgery you need depends on the stage of your cancer. The tests you have beforehand will help your specialist decide if surgery is an option for you. But your doctor may not be able to tell you exactly what stage your cancer is until after your operation.

 

Surgery to remove the cancer

There are a number of different operations to remove cancer of the mouth or oropharynx. For some very early stage cancers you may be able to have laser surgery under local anaesthetic or general anaesthetic but this is not common. Laser surgery uses a very thin beam of light to cut away the cancer cells. 

Most of the operations for mouth or oropharyngeal cancer are major surgery. You will have a general anaesthetic. So you will be asleep for the whole operation. The amount of tissue the surgeon takes away will depend on where the cancer is. For example, if a large part of your tongue is involved you may need to have a lot of your tongue removed (a glossectomy).

Some of these operations cause changes to the way you look, eat, speak and cope with life. We only describe the actual types of operations in this section. Our section about living with mouth and oropharyngeal cancer has information about how to cope with any changes that surgery can bring. If you are having major head and neck surgery, you will need to talk over all the options in detail with your surgeon.

There is information below about operations for

Removing the tumour and surrounding tissue

This is also called a primary tumour resection. The surgeon removes all of the cancer with an area (margin) of normal tissue surrounding it. This helps to make sure that all the cancer has gone. The surgeon will send all of the tissue to the laboratory. In the laboratory a pathologist examines the tissue. If there are no cancer cells at the edge of the tissue they call it a clear margin.

If your tumour is small and easy for your surgeon to reach, they will do the surgery through your mouth. But if it is a larger tumour or involves the oropharynx (throat), your surgeon will either make a cut through your neck or into your jawbone (known as a mandibulotomy) to reach the tumour.

Removing part or all of your jawbone (mandible)

If there is a chance that the cancer has spread to your jawbone, your doctor will suggest a mandibular resection. This is an operation to remove some or all of the tissue and bone in your jaw as well as the tumour. You may have a

Partial thickness resection

A partial thickness resection means removing the thin layer of bone of the mandible that contains the teeth. You might have this if your doctor thinks the cancer could have spread to your jawbone even though there is no sign of this on an X-ray. Your doctor may suspect this if it is hard to move the tumour from side to side when feeling inside your mouth.

Full thickness resection

A full thickness mandibular resection means removing all of the bone in your jaw. You may have this if an X-ray shows signs that the cancer has spread into the jawbone.

Removing part or all of the bones in the roof of your mouth

If you have a tumour affecting the bones in the roof of your mouth (the hard palate) you will need to have one or more of these removed (a maxillectomy). There are two possible operations

  • A partial maxillectomy or
  • A full maxillectomy

Both these operations leave a space in the roof of your mouth into the nose above. Your surgeon may be able to rebuild this area (reconstruction). Or a restorative consultant can make a false part (a prosthesis) to fill the space and make a new seal between the nose and the mouth.

Removing layers of your lip (Mohs’ surgery)

Mohs’ surgery is also called micrographic surgery. It is an advanced treatment procedure for skin cancer. If the cancer is in your lip, this type of surgery is very effective. The Mohs’ method involves taking away the cancer in very thin slices. Your doctor will examine each slice under a microscope for cancer cells before taking another slice. They stop when they find a slice free of cancer cells.

Moh's surgery is very useful in this situation because the amount of tissue removed may make a great deal of difference to your appearance. Examining every slice means that the doctor can remove the minimum possible amount of tissue.

Removing part or all of your tongue (glossectomy)

Partial glossectomy means removing part of the tongue. Total glossectomy means removing all of your tongue. These operations sound frightening and you will probably feel quite shocked if you are told that you need a glossectomy. These types of surgery are only ever done if it is absolutely necessary to remove the cancer. It may be possible to use radiotherapy or chemotherapy or both instead, to try to cure the cancer. 

Your surgeon will talk to you before the surgery about the possible effects of glossectomy. Surgery to the tongue can make a lot of difference to your speech and may cause changes in eating and drinking.

A partial glossectomy means removing less than half your tongue. You may have speech changes after this operation. 

If you need a total glossectomy, (more than half your tongue removed) your surgeon will rebuild (reconstruct) your tongue. Speech and swallowing will be more difficult after the operation. If you need a total glossectomy there is a lot of support to help you cope afterwards. There is information about changes in your speech and coping with mouth and oropharyngeal cancer in the section about living with mouth and oropharyngeal cancer.

Removing part or all of your larynx

Sometimes large tumours of the tongue or oropharynx mean that your surgeon needs to remove tissue that helps you swallow. A possible complication would be that food could then get into your windpipe (trachea) and lungs. This would be very dangerous as it could lead to choking and chest infections. If this is going to be a risk, your surgeon may also remove all or part of your voice box (larynx) along with the tumour in your mouth or throat. Removing the larynx is called a laryngectomy.

Your larynx is the connection between your mouth and your lungs which allows you to breathe. If your larynx is removed, the surgeon attaches the end of your windpipe to a hole made in your neck. You then breathe through the hole. The opening in your neck is called a stoma or tracheostomy.

A permanent tracheostomy is a rare operation for cancer of the mouth and oropharynx. There is information about having a breathing stoma in our section about living with mouth and oropharyngeal cancer. There is also detailed information about partial laryngectomy and total laryngectomy in the cancer of the larynx section.

 

Reconstruction surgery with flaps, skin grafts or bone

If you have a large area of tissue removed during your operation, your surgeon will rebuild (reconstruct) the area. They can do this 

Using tissue from another part of the body

An operation that moves tissue from one part of the body to another is called a reconstruction free flap or flap repair. Your surgeon can replace sections of the mouth or throat removed during head or neck cancer surgery. They may take tissue from an area such as the bowel or muscles in the arms, back or tummy. During the surgery the surgeon may use micro vascular techniques to sew together tiny blood vessels under a microscope. This is very specialised surgery carried out by a specially trained maxillofacial surgeon.

After a flap repair, your nurses and doctors will keep a close eye on the operation site. They will make sure the flap is getting a good supply of blood to bring oxygen and nutrients to the healing tissues. You may have a tiny probe put into the area for a while to help your doctors and nurses make sure that the flap is working well. 

Skin grafting

A skin graft means replacing an area of skin with another piece taken from elsewhere in the body. Your surgeon may use a skin graft to cover the area where they take tissue for your free flap. This type of operation is not commonly used these days. The surgeon removes a thin sheet of skin from somewhere not too obvious, such as your inner thigh or forearm (the donor site). They put the sheet of skin over the area that needs to be covered. 

After the operation the donor site looks like a large graze. The skin grows back quite quickly over a couple of weeks. Sometimes a thicker section of skin for the graft is cut out, and the donor site is repaired by stitching it back together.

After skin grafting the new skin often looks different from the surrounding area. It may be a different colour and slightly lower than the surface of the skin around it. This can affect your feelings about how you look, and may be difficult to cope with. There is information about changes to your appearance in the section about living with mouth and oropharyngeal cancer.

Taking bone from another part of the body

If your surgeon needs to take away part of your jawbone they may replace it using bone taken from the hip, lower leg or back.

 

Removing teeth and putting in dental implants

You may need to have some or all of your teeth removed before your surgery or radiotherapy treatment. You may also need to have dental implants put in during or after your surgery. Your restorative dentist will talk this through with you before your operation. They will be happy to answer your questions. They will be aware that you may be very worried and upset about having your teeth removed. So don’t be afraid to find out all you need to. You will find things easier to cope with if you understand exactly what is going to happen.

 

Removing lymph nodes in your neck

Cancers of the mouth and oropharynx sometimes spread to the lymph nodes in the neck. If the surgeon knows before your surgery that there are cancer cells in the lymph nodes they will remove some or all of the nodes in your neck during the operation to remove the cancer. This is called a neck dissection.

Surgeons don’t do a neck dissection routinely for everyone with mouth cancer because it can have long term side effects. Sometimes the surgeon doesn't know before the surgery whether there are cancer cells in the lymph nodes. In that situation they will suggest removing the nodes closest to the cancer. The surgeon sends the nodes to the laboratory to check them for cancer cells. 

If there is cancer in the lymph nodes, you may need to have more of the nodes in your neck removed or have radiotherapy to that area. If you don't have the affected nodes removed or radiotherapy treatment, the cancer cells will continue to grow.

 

Neck dissection

Neck dissection surgery means removing all or some of the lymph glands or other structures in your neck. Surgeons don’t remove lymph glands routinely for everyone with mouth cancer because a neck dissection can have long term side effects. They have to consider carefully which patients might benefit from it. The different types of neck dissection include

Selective neck dissection

If you have a selective neck dissection, the surgeon removes lymph nodes from some areas of your neck.

Modified radical neck dissection

There are different types of modified radical neck dissection. Your surgeon may just remove most of the lymph nodes between your jawbone and collarbone on one side of your neck. Or they may also remove one or more of the following structures

  • A muscle at the side of your neck called the sternocleidomastoid muscle
  • A nerve called the accessory nerve
  • A vein called the internal jugular vein

Diagram showing the muscle, nerve and blood vessel sometimes removed with a lymph node dissection of the neck

Radical neck dissection

If you have a radical neck dissection, your surgeon will remove nearly all of the nodes on one side of your neck, as well as the whole sternocleidomastoid muscle and nerve tissue, and the internal jugular vein.

 

Possible effects of neck dissection

Sometimes a neck dissection operation gives the best chance of stopping the cancer from spreading or coming back. But it can cause side effects. The effects depend on which structures in the area are damaged or removed during the surgery.

The accessory nerve controls shoulder movement, so if it is removed, your shoulder will be stiffer and more difficult to move. If you have a selective or modified neck dissection, the weakness in your arm usually lasts only a few months. But if your accessory nerve is removed during a radical neck dissection, the damage is permanent. Your doctor will refer you to a physiotherapist, who will show you some exercises. The exercises help to improve the movement in your neck and shoulder. It is important that you do these exercises regularly.

If you still have problems with pain and movement a year after surgery, your doctor may suggest a further operation to reconstruct some of the muscles. But this surgery will not be suitable for everyone.

Removing all of your sternocleidomastoid muscle will make your neck look thinner and sunken on that side.

Other common side effects of any neck dissection are caused by damage to some of the nerves that go to the head and neck area. They include

  • Numbness in the ear on the same side as the operation
  • Loss of movement in the lower lip
  • Loss of movement on one side of the tongue
  • Loss of feeling on one side of the tongue
 

Surgery to help you breathe or eat

Your doctor may suggest surgery if your cancer is blocking any part of your throat and making it difficult for you to breathe and swallow. Your doctor may suggest a

Tracheostomy

If the cancer is blocking your throat or is too big to completely remove, you may need an operation called a tracheostomy. The surgeon makes an opening in the front of your neck to bypass the tumour and allow you to breathe more easily. The hole in your neck is called a stoma. If your surgeon expects you to have a lot of swelling in your mouth and throat after your surgery, you may have a temporary tracheostomy to help you breathe until the swelling goes down.

Gastrostomy tube

A gastrostomy tube is also called a PEG tube. PEG stands for percutaneous endoscopic gastrostomy. You have a tube put into your stomach or small intestine through an opening made in your abdomen (a stoma). This can be used after surgery until you can eat normally again. Or it can be a good, long term, solution if you can't eat because of problems with swallowing. For as long as you need to, you can have liquid feeds through the tube and directly into your stomach.

You usually have the tube put in as an outpatient. This procedure is called an endoscopy. You swallow a long flexible tube into your stomach. This can be uncomfortable and your doctor will give you medicines to make you sleepy. Many people say that they can't remember what happened afterwards. Or your doctor can put the tube in during surgery, through a small cut in your abdomen. If you are worried about having an endoscopy while you are awake, do talk to your doctor or nurse about it. It may be possible to have a short anaesthetic if it would make you feel more comfortable.

If your swallowing problems are temporary you can have another type of tube called a nasogastric tube. The tube goes down your nose and throat and into your stomach. Once you can swallow more easily, your nurse will take it out. You can have all or some of the nutrition you need through these tubes as liquid meals.

There is detailed information about tube feeding in our section about diet problems and cancer.

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Updated: 14 October 2014