This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on May 19, 2022.
After a patient is diagnosed with head and neck cancer, the care team may recommend a specific surgical treatment depending on the type and stage of the disease.
Flexible robotic surgery is a minimally invasive treatment option for some head and neck cancer patients that allows surgeons to access hard-to-reach areas of the mouth and throat using a flexible scope.
With this technique, a long surgical instrument is used to remove the outer layers of tissue on the vocal cords. This approach may be used to take a biopsy sample, or to treat some stage 0 head and neck cancers confined to the vocal cords. Vocal cord stripping rarely impacts speech.
In laser surgery, an endoscope with a high-intensity laser on the tip is inserted down the throat. The tumor can then be vaporized or cut out using the laser.
In a cordectomy, part or all of the vocal cords are removed. This approach may be used to treat glottic cancer that is very small or located only on the surface tissues. Patients who receive a cordectomy may experience changes in speech. Removing part of a vocal cord may lead to a hoarse voice. If both vocal cords are removed, speech is no longer possible.
During a laryngectomy, the surgeon removes part or all of the larynx, also known as the voice box.
For small laryngeal cancers, it may be possible to remove only the portion of the voice box affected by the cancer, leaving the rest of the larynx intact. A partial laryngectomy may be used to remove the portion of the larynx above the vocal cords (supraglottic laryngectomy), or only one of the two vocal cords (hemilaryngectomy).
For more extensive laryngeal cancers, a total laryngectomy may be the recommended treatment. With this procedure, the entire voice box is removed. Then, in a process known as a tracheostomy, the windpipe is surgically moved toward a hole in the neck for breathing. For patients who follow this treatment option, normal speech is no longer possible, but other forms of speech can be learned. Foods and liquids can be swallowed normally, just as they were before the procedure.
During a myocutaneous flap procedure, the surgeon reconstructs the throat using muscle and skin from a nearby area that is rotated toward the throat.
During a pharyngectomy, the surgeon removes part or all of the throat where the cancerous cells are located.
Using microvascular surgery, in which small blood vessels are sewn together under a microscope, it may be possible to reconstruct the throat using tissues from other areas of the body, such as the intestines or arm muscle.
Cancer of the pharynx sometimes spreads to the lymph nodes in the neck. If such spreading seems likely, then lymph node removal surgery, called lymphadenectomy, may be recommended. Using a surgical procedure known as a neck dissection, this operation is usually performed at the same time as surgery to remove an already existing tumor. The exact amount of tissue that needs to be removed depends on the stage of the cancer.
With the most invasive procedure, some nerves and muscles that control neck and shoulder movement may be removed with the lymph nodes. However, surgery of this kind typically does not need to involve as much of the healthy tissue, preserving the normal function of the shoulders and neck.
A tracheotomy is performed to create an alternate pathway for breathing by creating a hole, or stoma, in the trachea, or windpipe. Various situations may require a tracheotomy. After a total laryngectomy, the opening in the windpipe is connected to an opening in the front of the neck to provide a new pathway for breathing. The resulting opening is known as a tracheostomy, and the changes it makes to the throat may be permanent.
The care team may choose to reconstruct areas of the head and neck affected by cancer with reconstructive microsurgery. It may be possible to reconstruct the nose, tongue or throat using tissues from other areas of the body, such as the thigh, abdomen or forearm. The lower jawbone (mandible) can be reconstructed using the smaller bone from the lower leg (fibula). For patients with facial paralysis secondary to tumor removal, transfer of a small muscle from the inner thigh can be performed to restore a smile.
Next topic: How is head and neck cancer treated with flexible robotic surgery?