[Recent advance in head and neck cancer surgery]

In order to remove a tumor radically, it is necessary to resect the tumor en-bloc together with surrounding normal tissues as much as possible. This results in a large tissue defect. Since the head and neck region has important functions for daily life such as respiration, speech, chewing, swallowing, the size of tissue defect directly affects post-operative functions and cosmetic results. Recently, the use of free flaps has made it possible to resect the advanced tumor which had been thought to be inoperable before. The introduction of free flaps has permitted reconstruction of the skull base, the nasopharynx, the mandible and the face. These were impossible to reconstruct with pedicled flaps such as delto-pectoral flap and pectoral major musculo-cutaneous flap. Therefore, the indication of reconstructive surgery has been remarkably enlarged for advanced head and neck cancer. We employed reconstructive surgery using free flaps for head and neck cancer in 1982, and, in August 1994, the number of patients operated on with free flaps reached 1,000. Through our experience of head and neck reconstructive surgery, we can conclude that the use of free flaps for the reconstruction in the head and neck region has permitted enlarging surgical indication for far advanced head and neck cancers. And the free flaps have made it possible to assure oral functions such as speech and chewing after reconstruction of the palate or the mandible. The use of free flaps has also decreased the incidence of postoperative complications such as fistula, infection, etc. It is incontestable that reconstructive surgery is indispensable for the treatment of head and neck cancer.