GP Update Head, Neck and Brain Cancers

Head and neck cancer: managing complications of surgery

An overview of the postoperative complications that could happen following surgery for head and neck cancer

29 August 2018

Treatment

The treatment plan for an individual patient with cancer of the head and/or neck depends on a number of factors, including the exact location of the tumour, the stage of the cancer, and the person’s age and general health. Treatment for head and neck cancer can include surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments.

Complications of surgery

Surgery continues to retain a pivotal role in head and neck cancer. Here we outline the postoperative complications that could occur, which patients should be made aware of prior to surgery being undertaken.

Complications associated with thyroid surgery include:

  1. Hypocalcaemia/hypoparathyroidism. One of the more common postoperative complications following thyroid surgery is hypocalcaemia. Hypocalcaemia is mainly attributed to hypoparathyroidism, when parathyroid glands are bruised or injured during surgery. Unfortunately, even when saved they may not work properly for a few weeks after surgery.
  2. Bleeding.
  3. Wound infection.
  4. Scarring. The scar may become relatively thick and red a few months after the operation, before fading to a thin line. Some patients may develop a hypertrophic scar or keloid depending on skin type. It takes about six months to one year for the scar to reach its final appearance.
  5. Voice change. Voice changes are more likely to occur in people who have very large goitres or cancerous tumours. Approximately 1 in 6 patients notice a change in the pitch of their voice, but most of these recover fully.
  6. Injury to the recurrent and/or superior laryngeal nerve.

Recurrent laryngeal nerve(s)

If ‘bruised’, the nerve does not work properly after surgery but recovers and returns to normal during the subsequent few days or weeks. Permanent damage to one of these nerves (risk is 1 in 100) and can cause hoarse, croaky and weak voice. The body usually adapts to the damage and symptoms may improve with time. Permanent damage to both nerves is very rare. This may require a tracheostomy which may be permanent.

Superior laryngeal nerve(s)

The external branch of the superior laryngeal nerve travels close to the vessels feeding the thyroid gland. These nerves control the tension of the vocal cords. Damage to one of these nerves results in a weak voice, although the sound of the voice will be unchanged.

Complications associated with neck dissection include:

  1. Bleeding.
  2. Wound infection.
  3. Scarring.
  4. Haematoma. Approximately 5 in 100 people.
  5. Lymph fluid leakage – chyle leak. Chyle leakage can occur in 1 to 3 people in 100 when performing neck dissection, with the majority of these requiring resections of lymph nodes low in the neck on the left side. This is usually managed conservatively with a low fat diet until leakage of the chyle has resolved.
  6. Nerve weakness or paralysis. This can be either temporary or permanent but often improves with physiotherapy. The nerves most at risk include the spinal accessory nerve (causing shoulder weakness), the greater auricular nerve (causing ear numbness), the facial nerve (causing facial muscle weakness, potentially leading to asymmetry); also, the marginal mandibular nerve branch of the facial nerve (causing weakness to the lower lip).

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