Head and neck tumours

The head, neck and mouth are the crossroads of our vital functions and our expression: eating, swallowing, speaking, breathing, smiling and conveying emotion. Faced with cancer of the mouth or the head and neck, surgical treatment must meet an uncompromising standard.

Two goals are pursued at the same time: definitive oncological eradication of the tumour and its lymph node spread, together with three-dimensional anatomical, morphological and functional restoration.

A specialist in head and neck surgery and maxillofacial surgery, Dr Yousefpour covers the whole high-precision care pathway: microscopically controlled tumour resection, curative surgical treatment of neck node metastases (neck dissection) and expert command of reconstruction with microvascular free flaps.

Beyond excision, Dr Yousefpour has in-depth training in reconstructive surgery: he fills the defects left by tumour removal with nearby muscle flaps or free flaps, taking into account both function and the contour of the face. His practice of facial aesthetic surgery leads him to apply facelift principles and techniques to reconstruction, for more discreet scars and a more natural appearance.

The protocol, step by step.

1. Step 1

   Precise staging

   Biopsy, dedicated imaging and local, regional and general staging before any treatment decision.

2. Step 2

   Resection in sano

   Removal of the primary lesion with microscopic safety margins, preserving the vital structures nearby.

3. Step 3

   Curative neck dissection

   Methodical removal of the at-risk or involved lymph node chains, with meticulous preservation of nerves and vessels.

4. Step 4

   Reconstruction and rehabilitation

   Reconstruction with a microvascular free flap, then morphological and functional rehabilitation and coordinated follow-up in a multidisciplinary team.

Common sites and anatomical challenges

The vast majority of tumours in this region are squamous cell carcinomas, affecting highly functional areas.

• Mobile tongue and floor of the mouth: direct risk of major impairment of speech and swallowing, with a strong potential for early spread to the neck nodes.

• Lower and upper jaw bone: involvement requiring complex bone resections (mandibulectomy, maxillectomy), for which immediate composite reconstruction is essential to maintain the structure of the lower face and the bite.

• Cheek lining, palate and oropharynx: restoring watertight, supple walls to preserve breathing and eating.

• Facial skeleton and salivary glands: meticulous dissection close to the motor branches of the facial nerve.

From radical resection to advanced microsurgery

• Radical oncological excision (in sano): oncological control with clear microscopic margins remains the absolute priority, without needlessly sacrificing vital structures nearby.

• Neck dissections (selective, functional or modified radical): the neck is the first station of tumour spread, hence the thorough removal of at-risk or involved lymph node chains.

• Meticulous preservation of nerves and vessels: systematic protection of the spinal accessory nerve (XI, shoulder movement), the hypoglossal nerve (XII, tongue movement), the vagus nerve (X) and the jugular-carotid axes.

• Aesthetic head and neck incisions: approaches strategically hidden in the natural skin creases of the neck.

• Plastic reconstruction and morphological and functional rehabilitation: local and regional mucosal and musculocutaneous flaps to rebuild the floor of the mouth, the tongue or the lip, prevention of scar depressions and visible asymmetry, restoration of mouth opening, speech, chewing and swallowing.

Expertise in reconstructive microsurgery: microvascular free flaps

For complex or extensive tissue loss, simple grafts or local flaps are no longer enough. Dr Yousefpour is experienced in revascularised free tissue transfer under the operating microscope.

• Composite bone flaps (fibula): vascularised bone to rebuild the lower or upper jaw entirely, restore facial projection and allow future implant rehabilitation.

• Thin fasciocutaneous or musculocutaneous flaps (radial forearm “Chinese” flap, anterolateral thigh flap, ALT): supple, vascularised tissue to create a mobile new tongue, seal the floor of the mouth or fill cheek volume without contraction.

• High-precision microvascular anastomoses: connecting the flap’s arteries and veins to the recipient vessels of the neck under surgical magnification, ensuring optimal tissue viability even in irradiated or complex areas.

Frequently asked questions

Will I definitely need a tracheostomy, and is it permanent? A tracheostomy is not systematic, but it is strongly recommended for extensive mouth resections combined with neck dissection and a free flap. In the vast majority of cases it is strictly temporary: it secures the airway during the initial swelling phase. Once the airway has settled and is clear, the tube is removed and the opening heals on its own within a few days.

How will I eat after the operation? For the first days, chewing and swallowing are impossible because of swelling and to protect the fine mucosal sutures. Nutrition is provided through a nasogastric tube or a gastrostomy tube. Once the surgeon confirms mucosal healing, eating by mouth (liquid, then blended) resumes under speech therapy supervision.

What is a microvascular free flap and why is it used? It is tissue from your own body (skin, muscle, bone) taken from another site (arm, thigh, leg) together with its feeding artery and vein. It is transferred to the head or neck, where its vessels are sutured to the neck vessels under the microscope. This advanced technique repairs large or complex tissue loss with a morphological, functional and aesthetic result far better than conventional techniques.

Why is neck dissection essential? Cancer cells from the mouth often spread to the lymph nodes of the neck, sometimes as micrometastases invisible on imaging. Neck dissection surgically clears these at-risk nodes, eradicates secondary deposits and provides precise histological staging to adapt further treatment.

Possible risks and complications

• General and local complications: compressive neck haematoma (surgical emergency), bleeding, wound infection, delayed healing, salivary fistula from a failed mucosal suture.

• Risks related to the microvascular flap: venous or arterial thrombosis of the microanastomoses requiring urgent re-operation to save the flap; partial or total flap necrosis; complications at the donor site (delayed healing, haematoma, temporary loss of sensation, visible scar).

• Risks related to neck dissection: reduced or lost skin sensation of the neck, chin or earlobe; injury or weakness of motor nerves (spinal accessory nerve XI causing shoulder weakness, marginal branch of the facial nerve causing lip asymmetry, hypoglossal nerve XII affecting tongue movement); lymph leak or neck lymphocele.

• Tracheostomy: tracheal secretions, bleeding around the trachea, lung collapse (atelectasis), rare tracheal stenosis, low neck scar.

• Swallowing problems and aspiration: risk of aspiration pneumonia requiring a temporary stop to eating by mouth.

• Nasogastric tube or gastrostomy: nasal and throat irritation, tube blockage, accidental displacement, haematoma or infection around the stoma for a gastrostomy.

• Histological control: if pathology shows close or involved margins (R1), further surgery or additional treatment (radiotherapy, chemotherapy) is discussed in the multidisciplinary team.

Medical information and informed consent

• Oncological excision of the primary tumour: resection of the malignant head, neck or mouth lesion with clear safety margins (in sano).

• Surgical treatment of lymph node metastases: methodical neck dissection to remove metastatic spread and prevent recurrence.

• Microvascular reconstruction with an autologous free flap: tissue taken from a distant site (arm, thigh, leg) and transferred to the neck or face with microsurgical arterial and venous anastomoses under the microscope.

• Airway and nutrition safety measures: a temporary protective tracheostomy and an enteral feeding device (nasogastric tube or gastrostomy) may be needed.

• Clear, honest and detailed information is given in a dedicated consultation, and a personalised consent document is provided so that you have the time you need before freely consenting to the operation.