What is Composite Resection ?
It is a surgical procedure performed to remove tumours present on the floor area of the mouth, tongue or jaw bone and may include removal of lymph nodes in the neck region, in certain cases. Healthy tissue obtained from the donor site or other parts of the body is used to replace the damaged area. The tissue is referred to as flap or graft and comprises of fatty tissue with blood vessels, muscle, cartilage or bone or skin. It comes under the branch of ENT procedures.
Why and when is composite resection advised ?
Complete assessment of the patient is done to evaluate the need for composite resection. The surgery is preferred to arrest the growth of the tumour and prevent it from spreading further into the oral cavity. The composite resection may be accompanied with radiotherapies or chemotherapy based on the patient’s prognosis. The surgeon performs composite resections to counter the effects of the tongue, jaw or neck cancers which mainly occur on account of excessive tobacco usage or alcohol abuse. The main target of the procedure would be to remove the damaged portion and stop malignancy.
The Procedure
It is a complicated procedure and needs to be done by expert ENT surgeons. Each resection has to be handled uniquely based on the individual anatomy and the multiple adjacent structures where the tumour is lodged. The surgeon and team involved check the size and shape of the tumour, its thickness, texture and the best possible way to remove it. There may be small lesions adjacent to the primary lesions which need to be extracted.
The surgeon targets the projected area and incisions are made at the accurate points to perform the procedure. The Jaw bone or mandible may be affected; the patient may end up losing one or more teeth in the process. Removal of part of jaw /whole jaw with adjoining buccal mucosa (inner lining of the cheek) without removal of skin of cheek may be considered. The gap appearing after surgical composite resection is rebuilt using a flap or graft obtained from the donor site usually the legs or thighs. The surgical wounds take about fifteen to twenty days to heal, the grated tissues start rebuilding on their own. The patient is required to stay under intensive care for the first two days post-surgery. The patient may have to stay in the hospital for a week or two until he recovers.
Post Procedural care points :
Breathing : The mouth is completely swollen after the surgery and the patient may experience breathing troubles. To assist the patient, to overcome this, a small incision is made in the front area of the neck and a tube or trach is inserted as a temporary arrangement.
Dressing/Drains : There will be tubes on the side of the neck or face to drain out excess fluid secretions. There may be dressing on the donor site, face or neck.
Nutrition : Faster healing directly corresponds to the nutrition the body receives. The patient may experience difficulty in swallowing until the swelling in the mouth comes down. The patient will have a small thin feeding tube in the nose to receive liquid nutrition and medicines. The feeding tube can be removed as soon as the condition improves.
Speech : The patient may not be able to speak properly post the procedure and speech therapist helps the patient regain his speech skills.
Pain Management : The patient may experience excruciating pain as composite resection may involve removal of mandible or jaw bone or section of nerves. Pain killers are given initially to ease the same. The patient must take due care to avoid excessive heat or cold drinks for few months.
Post- composite resection complications: There are certain risks associated with the procedure like:
- Numbness or soreness at the area of resection
- Loss of speech
- Difficulty in swallowing solid foods
- Temporary or permanent nerve damage
- Breathing difficulties
Most of the complications can be addressed through physiotherapy, speech therapy or other methods.
What do at Home ?
The patient must be given good nutritious food and rest to recover. Always keep the patient happy, and check on the following aspects :
- The patient must raise his head to 30 degrees for few days
- Avoid sleeping on the side incisions are present
- Avoid alcohol or smoke
- Strenuous activity must be avoided
- Call the health-care provider if any redness, swelling or pus is found at the site of the incision.
- Fever that does not subside must be reported to the doctor
- Pain that increases
- The site of the flap or graft that becomes pale or yellow
- Bleeding that soaks the dressing very quickly
At KIMS, Cancer treatments are our expertise. We have the best doctors well trained in composite resections. Professional treatment with personal care has ensured positive outcomes in very critical ENT cancer treatments.