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Maureen, Volunteer Mentor
@alpaca

Posts: 203
Joined: Nov 17, 2016

Reconstruction for head and neck cancers

Posted by @alpaca, Fri, May 25 5:11pm

As many of you know, we head and neck cancer patients need major reconstruction after big cancer removal surgeries. We need free forearm flaps or fibula flaps or flaps of bony of soft tissue from all over the body. And all these flaps need to be taken with a long string of blood vessels which are then joined to blood vessels in the head and neck. It’s often difficult to avoid nerve damage and hard to achieve a result that is socially acceptable. (A term I heard a patient use, “How can I make this socially acceptable?”)
We are now on a review and implementation team to improve services in Auckland using the patient voice as a help.
My question is this: did people in the US and Canada and elsewhere have a plastic surgeon present at the initial surgery? Did they have a maxillofacial surgeon or oral surgeon? Our feeling is that just having an ENT surgeon to remove the cancer and then a microvascular trained ENT to reconstruct might not be giving complex patients the best outcome. Just askin’

REPLY

Hi Maureen! Great topic of conversation. Thank you for starting it!
I love that you are part of a patient review and implementation team- Would you mind sharing how it was started and how many members you have? I'm interested in knowing because it would be nice to have one in Rochester. How often do you all meet?

I think your patient review and implementation team is correct in stating that head and neck cancer reconstruction is complex and requires expertise, thought, and careful execution. However, I feel it's incorrect in thinking that this is done better by a certain specialty- those are only names. You could be a maxillofacial surgeon or an ENT-trained head and neck surgeon specializing in head and neck microvascular reconstruction and have far more experience in head and neck reconstruction than a plastic surgeon, for instance, who might do far more breast reconstruction than mandible reconstruction. At Mayo Clinic, Rochester, the head and neck ENT surgeons do far more cancer reconstruction than the other specialties. In another institution, it might be the plastic surgeons or maxillofacial surgeons who do the most. The key is that experience and repetition builds competence- use the most experienced surgeons, use groups who work as a team- and the best results will follow. 🙂

Thank you @jamienolson This is just the sort of answer I was seeking. In Auckland, New Zealand, we have three (four if you include an allied region) district health boards with different pockets of specialties spread across two of them particularly. When a review of the overall service was called for, our support group was able to get one member on the review team and five of us on the co-design, models of care, workshops. There is a feeling from some patients (and surgeons in other hospitals) that a competitive culture has prevented some patients getting the best outcome for their jaw surgery.
The whole process will probably take a year and is very intense and comprehensive.
One problem is teeth related. We feel that our service could do better to plan for implants before surgery (I'm getting into tricky territory here as I only half understand it).

I'd like to invite fellow members of the Head & Neck Cancer group to join this topic about reconstruction. @jeffk @lisa_sj99 @jtw96 @mrsjhagen18 @sylviapf @lzzie @loli @karly @trudivo @angelag @ssimons @deborahe @gaybinator @emmur16 @udderplace @carebear @hoppy @ileanabalcu Would love to get your thoughts on Maureen's questions.

@colleenyoung

I'd like to invite fellow members of the Head & Neck Cancer group to join this topic about reconstruction. @jeffk @lisa_sj99 @jtw96 @mrsjhagen18 @sylviapf @lzzie @loli @karly @trudivo @angelag @ssimons @deborahe @gaybinator @emmur16 @udderplace @carebear @hoppy @ileanabalcu Would love to get your thoughts on Maureen's questions.

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I was very blessed to have had a great team of doctors for my surgery. It took a long time, 20 hours. My doctor, who is the Head and Neck head at University of Maryland, is a maxillofacial surgeon: the dentist they sent me to at the University is a maxillofacial surgeon as well; the microvascular doctor was a plastic surgeon also. I do not look like a movie star, and sometimes I feel like I should consult with a really good plastic surgeon to take care of the imperfections; but then, at this point in my life, there are things that are more important to me. We, cancer survivors should be not only socially accepted, but admired.
But I know where you are coming from, and I would recommend anyone having head and neck surgery, to make sure they are having a team of doctors including a plastic surgeon that would help patients have the best opportunity to look socially acceptable after their surgery.
My sister was treated at the Mayo clinic in Scottsdale for jaw cancer, and she also had a fantastic team of doctors, including a dietitian. We, in the USA have many choices and great institutions.
Thank you Alpaca. You are a great example of being proactive and involved in helping others. Thank you

Thank you again @loli WE had a very interesting discussion with the local medical team about getting the balance right between the different surgical sub-specialties. Removing the cancer is only part of the process.

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