Oncological Surgery, Neck Dissection & Advanced Reconstructive Microsurgery (Free Microvascular Flaps)
Facing cancer of the cervico-maxillofacial region: radical oncological rigor and cutting-edge microvascular reconstruction.
The head, neck, and oral cavity are at the crossroads of our vital functions and our expression: eating, swallowing, speaking, breathing, smiling, and conveying emotion. When facing a cancer of the mouth or the cervico-facial region, surgical care must meet an uncompromising standard: definitive oncological eradication of the tumor and its lymph node spread, combined with a three-dimensional restoration of anatomy, form, and function.
As an exclusive specialist in head and neck surgery and maxillofacial surgery, Dr Yousefpour integrates the entire high-precision care chain into his practice: microscopically controlled tumor resection, curative surgical treatment of neck lymph node metastases (neck dissection), and expert mastery of reconstruction using autologous free microvascular flaps.
Common Locations and Anatomical Challenges
The vast majority of tumors in this region are squamous cell carcinomas, affecting highly functional areas:
- Mobile tongue and floor of the mouth: A direct risk of major impairment to speech and swallowing, with a strong potential for early spread to the neck's lymph nodes.
- Mandibular and maxillary bones: Involvement requiring complex bone resections (mandibulectomy, maxillectomy), for which immediate composite reconstruction is essential to maintain the architecture of the lower face and dental occlusion.
- Cheek lining, palate, and oropharynx: Requiring the restoration of watertight, flexible walls to preserve breathing and eating function.
- Facial skeleton and salivary glands: Requiring meticulous dissection in contact with the motor branches of the facial nerve.
Dr Yousefpour's Specialized Approach: From Radical Resection to Advanced Microsurgery
Precise Staging Assessment ➔ Resection In Sano ➔ Curative Neck Dissection ➔ Free Microvascular Flap Reconstruction ➔ Morpho-Functional Rehabilitation
1. Radical Oncological Excision (In Sano)
The absolute priority remains oncological control, achieved by obtaining microscopically clear safety margins. Dr Yousefpour's in-depth knowledge of cervico-maxillofacial anatomy allows him to resect even the most complex primary lesions without unnecessarily sacrificing nearby vital structures.
2. Definitive Surgical Treatment of Lymph Node Metastases: Neck Dissection
The neck represents the first site of tumor spread. Dr Yousefpour provides complete management of the lymph node status:
- Planned neck dissections (selective, functional, or modified radical): Thorough removal of lymph node chains that are at risk or already involved.
- Meticulous neurovascular preservation: Systematic protection of the spinal accessory nerve (XI — shoulder mobility), the hypoglossal nerve (XII — tongue movement), the vagus nerve (X), and the jugular-carotid vessels.
- Aesthetic cervico-facial incisions: Surgical approaches strategically hidden within the neck's natural skin creases.
3. Plastic Reconstruction and Morpho-Functional Rehabilitation
After removal, restoring the integrity of the mouth and the contours of the face is essential:
- Loco-regional mucosal and musculocutaneous flaps: Transposition of healthy, vascularized tissue to rebuild the floor of the mouth, the tongue, or the lip.
- Preserving facial contours: Preventing scar depressions and visible asymmetries.
- Restoring function: Maintaining mouth opening, speech, chewing, and swallowing.
Expertise in Reconstructive Microsurgery: Free Microvascular Flaps
For complex or extensive tissue loss, simple grafts or local flaps are no longer sufficient. Dr Yousefpour is skilled in free tissue transfer, revascularized under an operating microscope:
- Composite bone flaps (e.g. fibula): A vascularized bone harvest used to fully reconstruct the mandible or maxilla, restore facial projection, and allow for future implant-based rehabilitation.
- Thin fasciocutaneous or musculocutaneous flaps (e.g. radial forearm flap, anterolateral thigh flap – ALT): Flexible, vascularized tissue used to recreate a mobile new tongue, seal the floor of the mouth, or fill cheek volume without contracture.
- High-precision micro-vascular anastomoses: Connecting the graft's arteries and veins to the recipient vessels in the neck under microsurgical optical magnification, ensuring optimal tissue viability even in complex or previously irradiated areas.
Frequently Asked Questions
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Will I definitely need a tracheotomy, and is it permanent?A tracheotomy is not required for every lesion, but it is strongly recommended for extensive oral resections combined with a neck dissection and a free flap. It is strictly temporary in the vast majority of cases: its role is to secure 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.
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How will I eat after the surgery?For the first few days after surgery, chewing and swallowing are not possible due to swelling and to protect the micro-sutures in the mucosa. Nutrition is provided through a naso-gastric tube (through the nose) or a gastrostomy tube (directly into the stomach). Once mucosal healing is confirmed by the surgeon, oral feeding (liquid, then blended) is reintroduced under speech-therapy supervision.
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What is a free microvascular flap, and why is it used?A free flap is a piece of autologous tissue (skin, muscle, or bone) taken from another part of the body (arm, thigh, or leg) along with its supplying artery and vein. It is transferred to the head or neck, where its vessels are sutured under a microscope to the neck's blood vessels. This advanced technique allows large or complex tissue defects to be repaired with a morphological, functional, and aesthetic result far superior to conventional techniques.
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Why is neck lymph node dissection essential?Cancer cells from the oral cavity frequently migrate to the neck's lymph nodes, sometimes as micrometastases invisible on imaging. Neck dissection allows these at-risk sites to be surgically cleared, eliminates secondary tumor deposits, and establishes a precise histological classification to guide the rest of your care.
Medical Information & Informed Consent Document
Cervico-Maxillo-Facial Oncological Surgery, Neck Dissection, Microvascular Reconstruction, Airway Management & Enteral Nutrition
Surgeon: Dr Yousefpour — Specialist in Head and Neck Surgery & Maxillofacial Surgery
Nature of the Procedure and Treatment Objectives
This document confirms that you have received clear, honest, and detailed information about your condition and the proposed surgical treatment, including:
- Oncological excision of the primary tumor: Resection of the malignant cervico-oral-facial lesion with clear (in sano) safety margins.
- Surgical treatment of lymph node metastases (neck dissection): Methodical, planned removal of the neck's lymph nodes to eliminate metastatic spread and prevent recurrence.
- Microvascular reconstruction with an autologous free flap: Tissue harvest from a distant site (arm, thigh, leg, etc.) and transfer to the neck/face, with microsurgical arterial and venous anastomoses under a microscope, aimed at restoring the shape, appearance, and function of the resected structures.
- Airway and nutritional safety measures: Possible placement of a temporary protective tracheotomy, and of an enteral nutrition device (naso-gastric tube or gastrostomy).
Risks and Possible Complications
Despite extreme technical rigor and microsurgical expertise dedicated to the head and neck region, all major oncological surgery carries inherent risk:
General and local complications:
- Compressive neck hematoma (a surgical emergency), bleeding, infection of the surgical site, delayed healing, salivary fistula from mucosal suture breakdown.
Risks related to the microvascular flap:
- Venous or arterial thrombosis of the micro-anastomoses, requiring emergency re-operation to salvage the flap.
- Partial or total loss of the graft.
- Donor-site complications: delayed healing, hematoma, temporary loss of sensation, a visible scar.
Risks related to neck dissection:
- Reduced or lost skin sensation over the neck, chin, or earlobe.
- Injury or weakness of motor nerves: the spinal nerve (XI), causing shoulder weakness; the mental branch of the facial nerve, causing lip asymmetry; the hypoglossal nerve (XII), affecting tongue movement.
- Lymphatic leak or a neck lymphocele.
Risks and effects related to breathing and nutrition:
- Tracheotomy: Tracheal secretions, peritracheal bleeding, lung atelectasis, rare tracheal stenosis, a low neck scar.
- Swallowing disorders & aspiration: Risk of aspiration pneumonia, which may require temporarily stopping oral feeding.
- Naso-gastric tube / gastrostomy: Nasal/throat irritation, tube blockage, accidental displacement, or hematoma/infection around the gastrostomy site.
Pathology control: If the pathology examination reveals close or involved margins (R1), a further surgical procedure or adjuvant treatment (radiotherapy/chemotherapy) will be discussed at a multidisciplinary team meeting.
Patient Declaration and Consent
This consent form is reviewed and signed together with Dr Yousefpour in person prior to the procedure — it is presented here for your information so you can review it in advance.