Types of surgery

There are different types of surgery for mouth and oropharyngeal cancer. The type you have depends on the size of your cancer and where it is.

Your surgeon removes your cancer and a border (margin) of normal tissue around it. You might also need surgery to your:

• jawbone or the roof of your mouth (hard palate)

• tongue

• voice box (larynx)

• neck, to remove lymph nodes

You might also have surgery to rebuild part of your mouth or throat (reconstructive surgery). And some people have surgery to help with eating or breathing.

How you have surgery for mouth and oropharyngeal

Surgery for cancer of the mouth and oropharyngeal can sometimes be a big operation. You usually have surgery under general anaesthetic. So you will be asleep for the whole operation. 

Your surgeon removes the cancer and a border (margin) of normal tissue around it. This checks there are no cancer cells left behind. The operation is called a primary tumour resection. 

A sample of tissue from around the cancer (margin) is sent to the laboratory. A specialist (pathologist) looks at the cells under a microscope to check for cancer cells. If there are no cancer cells, it is called a clear margin. 

You can have different types of primary tumour resection. It depends on where the cancer is. 

Transoral surgery

You might have surgery through your mouth (transoral surgery). You can usually have transoral surgery if you have an early stage cancer, which is easy to reach. 

You will not have any scars on your face after transoral surgery. But you might have scars on your neck if you also need surgery to remove lymph nodes in your neck.

Open surgery

Open surgery means the surgeon will make a cut through the skin to do the operation. You might need to have open surgery if you have a large cancer, or if your cancer is difficult to reach through your mouth. 

This means you will have a scar after open surgery. Your surgeon will show you where your scar will be.

Surgery to remove the cancer through your mouth (transoral surgery)

When the cancer is small and easy to reach, you have the surgery through your mouth. This is called transoral surgery. Your surgeon might use different types of transoral surgery. These include:

• transoral laser microsurgery (TLM)

• transoral robotic surgery (TORS)

Transoral laser microsurgery means your surgeon uses a laser to cut through tissue in the same way as a surgical knife (scalpel). The type of laser most often used is a carbon dioxide laser.  

For robotic surgery, your surgeon uses a robotic system. They control the robot's arms. The arms connect to the instruments the surgeon uses for the surgery. This helps the surgeon do more complex surgery.

The benefits of transoral surgery include a quicker recovery time and fewer problems afterwards. 

Sometimes it might be difficult to remove your cancer through your mouth. Your surgeon may need to make a cut in your neck or jawbone (mandible) to reach the cancer.

Transoral robotic surgery is not suitable for everyone and not all hospitals can offer this. Do ask your surgeon for more information.  

Surgery on the lips

If the cancer is in your lip, micrographic surgery can work well. This is also called Mohs micrographic surgery. This type of surgery involves removing a small piece of tissue.

Your doctor looks at the tissue under a microscope before removing more. They stop when they find tissue that is free of cancer.

Examining every small piece of tissue means the doctor can remove the minimum possible amount of tissue.

Surgery on the jawbone

Mouth and oropharyngeal cancer can sometimes spread to your jawbone. Your surgeon might need to remove some or all the tissue and bone in your jaw. This is called a mandibular resection. 

There are 2 types of mandibular resection:

• partial thickness (also called a partial or marginal mandibulectomy)
• full thickness (also called a total or segmental mandibulectomy)

Partial thickness resection

You have the thin layer of bone removed. This layer contains the teeth. You might have this if your doctor thinks the cancer has spread to your jawbone, even though there is no sign of this on an x-ray. 

Full thickness resection 

You have all or part of the jaw removed. You may have this if an x-ray shows that your cancer has spread to your jawbone or is very close to it. This surgery is usually for more advanced cancer and ensures that the cancer is fully removed.

Surgery on the bones in the roof of the mouth (hard palate)

The bones in the roof of the mouth are called the hard palate. You might have surgery to remove cancer affecting the hard palate. The operation is called a maxillectomy. You might have surgery to remove:

• all of the bones in the roof of your mouth (total maxillectomy)
• some of the bones in the roof of your mouth (partial maxillectomy)

Both types of surgery leave a space in the roof of your mouth into the nose above. Your surgeon may be able to rebuild this area (reconstruction). Or a restorative consultant can make a false part (a prosthesis or an obturator) to fill the space and make a seal between the nose and the mouth. 

Surgery on the tongue

Surgery to remove the tongue is called a glossectomy. There are 2 types of glossectomy: 

• partial glossectomy
• total glossectomy

Partial glossectomy 

The surgeon removes less than half of your tongue. You may have changes to your speech after this operation. 

Total glossectomy 

This means removing more than half or all of your tongue. Your surgeon will rebuild (reconstruct) your tongue. But your speech and swallowing will change after the surgery. You will have a lot of support to help you cope afterwards. 

Your surgeon and specialist nurse will explain more about the type of surgery you may have on your tongue. They will also tell you how it will affect your speech and swallowing and explain ways to help. 

Surgery on the voice box (larynx)

This type of surgery is rare for mouth and oropharyngeal cancer. 

Sometimes large tumours of the tongue or oropharynx mean that your surgeon needs to remove tissue that helps you swallow. A possible complication is food going into your windpipe (trachea) and lungs. This can cause choking and chest infections. 

To lower the risk of choking or infection, your surgeon might remove all or part of your voice box (larynx) as well as the cancer. This is called a laryngectomy.

The larynx connects the mouth and lungs. It allows you to breathe. If the surgeon removes your larynx, they attach the end of your windpipe to a hole made in your neck. You then breathe through the hole. This hole or opening in your neck is called a stoma.

Surgery to your lymph nodes

Cancers of the mouth and oropharynx can spread to the lymph nodes in the neck.

If your cancer is very large or your surgeon knows there is cancer in your lymph nodes.

You have surgery to remove some or all of the lymph nodes in your neck. This is called a neck dissection.

If your surgeon doesn’t know if there is cancer in your lymph nodes.

Your surgeon might suggest:

• removing a few lymph nodes closest to the cancer on one side of the neck to check for cancer - this is called a selective neck dissection

• a sentinel node biopsy - this test checks the first lymph node that cancer can spread to (sentinel node)

Surgery to rebuild your mouth or throat (reconstruction surgery)

Your surgeon might need to remove a large area of tissue. They will rebuild (reconstruct) the area. 

There are different ways of doing reconstruction surgery. These include using:

• tissue from another part of the body (a flap)

• skin from another part of the body (a skin graft)

• bone from another part of the body (a bone graft)

Possible risks of surgery

Your surgeon will discuss what your operation involves and the possible risks. These depend on the type of surgery you have. 
Some types of surgery may change:

• the way you look
• how you chew and swallow
• how you breathe
• how you speak
• your sense of smell

Your surgeon will always try to avoid changing your appearance. They will try to keep your breathing, speech, and eating as normal as possible. But sometimes this is not possible, and you will have changes to deal with. Your doctors will make sure the benefits of having surgery outweigh these possible risks.

Coming to terms with the changes may be hard at first. And you may need some time to get used to them.