Prehabilitation in Head and Neck Surgery and Reconstruction

Head and neck surgery and reconstruction for malignancy often results in significant functional, nutritional, and psychological morbidity that can delay recovery and impair quality of life. Prehabilitation offers a multimodal, proactive approach to optimize patients before surgery by targeting modifiable risk factors and baseline impairments.

In this narrative review, we synthesized current evidence and clinical guidelines across 6 domains of prehabilitation, medical risk assessment, nutritional optimization, swallowing therapy, pain management, physical conditioning, and psychological support, to provide a practical framework for perioperative teams.

Early identification and treatment of tobacco, alcohol, and cannabis use, along with correction of preoperative anemia, can reduce perioperative morbidity and the need for transfusion. Nutritional prehabilitation initiated at or near the time of diagnosis, and ideally continued throughout neoadjuvant therapy, uses validated screening tools; individualized dietetic counseling; and, when indicated, immunonutrition and enteral support to mitigate malnutrition and improve wound healing. Baseline swallowing assessment with bedside screening and instrumental studies, followed by targeted exercise programs, helps preserve function and support adequate oral intake. Preoperative multimodal analgesia, structured aerobic and resistance exercise (including respiratory training), and psychological interventions, such as psychoeducation and cognitive behavioral therapy, collectively enhance adherence to rehabilitation, support emotional coping, and improve functional recovery.

Multimodal, multidisciplinary prehabilitation should be considered an essential component of surgical preparation for patients undergoing head and neck surgery and reconstruction, with patient-centered care plans tailored to individual risk profiles to improve postoperative outcomes and overall quality of life.