Surgery for Mouth (Oral) Cancer
Overview
Surgery is the most common treatment for mouth cancer. Your surgeon will talk with you about which surgery is best for you, based on the:
- Type of oral cancer
- Stage
- Location of the tumor
- Tumor’s characteristics, including its genetic information
MSK head and neck surgeons may be able to use minimally invasive methods that do less harm to the body. You may recover faster, with fewer side effects. Surgery may sometimes be used along with other therapies.
At MSK, mouth cancer surgery and mouth reconstruction often are done during the same procedure. Your surgeon also may remove lymph nodes in your neck. That’s because cancer is already in the lymph nodes or likely to spread there. This procedure lowers the chance the cancer may come back.
Some people may have dental implants if they have surgery on their jawbone or gums.
Talk with an MSK Care Advisor. We're here 24 hours a day, 7 days a week.
What happens during mouth cancer surgery
Many people with oral cancer have surgery to remove the tumor. You may also need to have tissue, muscle, or bone reconstruction during surgery. If so, you’ll have reconstruction after your surgeon removes the mouth cancer. A plastic surgeon or a head and neck surgeon expert in reconstruction will do the reconstruction.
You may also see a dental and maxillofacial (max-ill-o-FAY-shul) surgeon if surgeons remove part or all of your jaw. You may need a prosthesis (pros-THEE-sis), a device that replaces a part of the body.
Here are ways your surgeons can remove mouth cancer tumors:
- They remove some tumors through an incision (surgical cut) in the jaw between the front 2 bottom teeth. After they remove the tumor, they put the jaw back together with a metal plate and screws.
- If the cancer affects a small piece of the jaw, they only remove that part of the bone.
- If the cancer affects a lot of the bone, they may remove a whole section of the jaw.
- If lymph nodes in the neck have or may have cancer, they may remove the nodes during mouth cancer surgery.
Types of surgery for mouth cancer
There are a few types of surgical oral cancer treatments. You may have tongue removal surgery, or jaw cancer removal surgery, based on the type of cancer.
Your surgeon will talk with you about which type you’ll have. We explain these surgeries in this section:
- Glossectomy
- Mandibulectomy
- Maxillectomy
You may have a tracheostomy or a neck dissection during mouth surgery. We’ll also explain those procedures.
Glossectomy for oral and tongue cancer
A glossectomy (glah-SEK-toh-mee) is surgery to remove tumors on the tongue. Your surgeon may need to remove part, half, or all of the tongue.
How much of your tongue is removed depends on the tumor’s size and location.
These are the main types of glossectomy
- Partial glossectomy: Only part of the tongue is removed.
- Hemiglossectomy: One side (half) of the tongue is removed.
- Total glossectomy: All of the tongue is removed.
Reconstruction of the tongue most often is done during the same surgery. Our head and neck surgeons and plastic surgeons are experts in rebuilding the tongue. They may do a tongue reconstruction procedure called a free tissue transfer.
During this procedure, skin and tissues are taken from your forearm or thigh to rebuild the tongue. Surgeons connect the blood vessels and nerves from the forearm or thigh tissue to those in the neck.
Our speech and swallowing therapy experts manage side effects of a tongue reconstruction, including changes in:
- Speech.
- How well your tongue can move.
- How well you can swallow.
Mandibulectomy for oral or jaw cancers
A mandibulectomy (MAN-dih-bul-EK-toh-mee) is surgery to remove all or part of your mandible (jawbone). This surgery is also called a mandibular resection. A mandibulectomy often treats mouth cancers that start in the lower gums or the floor of the mouth.
The amount of bone that must be removed depends on the tumor’s location.
Types of mandibulectomies
A marginal (partial) mandibulectomy is when your surgeon removes a small part of the jawbone. They cover the incision (cut) with a skin graft. You will not need reconstruction of your jawbone.
A segmental mandibulectomy is when your surgeon removes a larger part of the jawbone. You’ll need surgery to rebuild your jawbone. This procedure is called a mandibulectomy and free-flap reconstruction.
Your surgeon will talk with you about how they’ll rebuild your jaw. Most jaw reconstructions use bone from your leg. They’ll also remove an artery, vein, and soft tissue with the bone. This procedure almost always uses bone to rebuild the jaw.
First, your MSK surgery team will remove the tumor from your jaw and nearby tissue. They’ll also remove the bone, tissue, and skin from another part of your body (the donor site). These are used to rebuild your jaw.
Reconstruction starts when the first surgery team is removing the tumor. The second surgeon takes the tissue from your donor site to rebuild your jaw. They’ll shape the bone from the donor site to closely match the part of your jaw they removed.
Your surgeon then takes the artery and vein from the donor site. They’ll attach it to an artery and vein in your head and neck so your blood can flow.
They’ll keep the new jawbone in place with plates and screws, and close the incisions (cuts).
The entire surgery takes 6 to 8 hours. This includes removing the tumor and the reconstruction part of a segmental mandibulectomy for jaw cancer.
Learn more about what happens during a segmental mandibulectomy.
Maxillectomy for mouth, gum, and hard palate cancer
A maxillectomy (MAK-sihl-EK-toh-mee) is surgery to remove tumors in the upper jawbone (maxilla). This procedure removes bones in the hard palate.
The hard palate is the bony front part of the roof of the mouth. Maxillectomy surgery often treats oral cancers that start in the hard palate or the upper gums.
The kind of maxillectomy you have depends on the tumor’s location and if it involves nearby tissue and structures. A maxillectomy can remove all or part of the upper jawbone, and other areas with a tumor, such as:
- Bone around your maxillary sinus (next to your nose).
- Bone of your hard palate (roof of your mouth).
- Upper teeth on one side of your mouth.
- Part of your entire orbit (eye socket).
- Part of your cheekbone.
- Part of the bony part of your upper nose.
Maxillectomy surgery leaves a space in the roof of your mouth. You may get a prosthesis called an obturator (plate). Or, your surgeons could reconstruct the upper jaw with a free tissue transfer using bone or soft tissue.
MSK has more than 70 head and neck cancer experts. We see more people with rare types of head and neck cancer than many other cancer centers. We’re experts in diagnosing and treating rare salivary gland, mouth, and thyroid cancers. That’s why 1,100 people with rare head and neck cancers come to MSK each year.
Procedures you may have during mouth surgery
You may have reconstruction with:
- An obturator (plate).
- Free flap.
- Tracheostomy.
- Sentinel node biopsy.
- Neck dissection during mouth surgery.
An obturator (plate) closes an opening between your nasal cavity and mouth. This can happen if a surgeon removes part of your hard palate.
A tracheostomy is a procedure to help you breathe more easily after surgery.
A neck dissection removes lymph nodes that have or may have cancer.
If your surgeon removes part of your hard palate, there may be an opening between your nasal cavity and your mouth.
Your dental surgeon will make a mold of your upper mouth before and the day of your surgery. During your maxillectomy surgery, they’ll put a surgical obturator (plate) to close the opening in your palate. This will help you speak and eat after surgery.
You’ll have this surgical obturator for about 2 weeks after your maxillectomy surgery. Then you’ll see your dental surgeon to remove and replace the surgical obturator.
During this visit, your dental surgeon will fit your mouth with an obturator that can come out. They’ll tell you how to clean and take care of the obturator. You’ll keep seeing your dental surgeon to check the obturator and adjust the fit if needed.
A tracheostomy (TRAY-kee-OS-toh-mee) is a procedure where your surgeon makes a stoma (opening) in your neck. They put a tube through the opening and into your trachea (TRAY-kee-uh). The trachea (windpipe) carries air in and out of your lungs to help you breathe.
Oral cancer surgery can cause swelling in your throat. Swelling can make it harder to breathe, so we do a tracheostomy to make it easier to breathe.
You may need a tracheostomy if you have these types of mouth surgery:
- A hemiglossectomy
- A mandibulectomy
- Some types of reconstruction or free flaps
Placement of a tracheostomy tube.
Before your surgery, your surgeon will talk with you about whether you’ll need a tracheostomy.
They’ll remove the tracheostomy tube when the swelling goes down, and you can breathe on your own. You will not need surgery to remove the tube. The opening will close on its own.
Learn more about caring for your tracheostomy.
Oral cancer often spreads first to the lymph nodes in the neck. The lymph nodes are small, bean-shaped structures that filter out waste products from your lymphatic system.
Your surgeon may do a sentinel node biopsy if the tumor is small and imaging shows nodes are not affected. This biopsy is instead of a neck dissection.
On the morning of the surgery, they’ll inject (put) a radiotracer agent around the tumor. MSK’s nuclear medicine team will take detailed images of your neck.
Based on these images, your surgeons can find the few lymph nodes that have the highest chances of spreading cancer. Only these lymph nodes will be removed.
This is a smaller surgery than if we removed all the lymph nodes from this area of the neck. You’ll have smaller incisions (cuts) and recover much faster.
A neck dissection surgery removes lymph nodes that have or may have cancer.
Types of neck dissection surgery
These are the types of neck dissections:
- Radical neck dissection: Removes all the tissue from the affected side of the neck. Your surgeon will also remove the muscle, nerve, salivary gland, and major blood vessels during a radical neck dissection.
- Modified radical neck dissection: Removes all lymph nodes and less neck tissue. The nerves in the neck and the blood vessels or muscle may not need to be removed.
- Selective neck dissection: Removes fewer lymph nodes. The nerves in the neck and the blood vessels or muscle may not need to be removed.
Chemo or immunotherapy before surgery can shrink tumors and make them easier to remove with surgery.
Thomas Ow:
The most exciting developments in the field really revolve around using chemotherapies and
immunotherapies pre-operatively to shrink tumors, make things smaller, so that when we do
surgery, the surgeries are much less complex. And we're finding that in many cases for many
different kinds of cancer, that often results in better survival outcomes as well.
At MSK, every specialty is at the forefront and when we work together to make a treatment
plan for each patient, they can be assured that they're getting the most advanced care from the
entire team.
- The tumor's location.
- If the cancer has spread to your lymph nodes.
- If the cancer has spread to other structures in your neck.
Lymph node removal is most common for cancers that start in the tongue, floor of the mouth, or lower gums.
Side effects of mouth cancer and its treatment can cause swallowing and speech trouble. It also can be hard to move your jaw. MSK has a team of experts in rehabilitation, speech pathology, and dental oncology (cancer care). They help you cope with the side effects of treatment.
Reconstructive surgery for advanced mouth cancer
For smaller mouth tumors: Your surgeon closes the affected area with stitches that will fade away. Sometimes they may use tissue to repair the area. A skin graft uses your own skin, while an allograft uses tissue from a donor.
For large mouth tumors: You may need reconstructive surgery to repair the area and to restore how the mouth works and looks.
During reconstructive surgery, your surgeon takes tissue and blood vessels from another area to repair the mouth. This is called a free tissue transfer.
Your surgeon may transfer tissue from your:
- Forearm
- Fibula (the smaller bone in the lower leg)
- Thigh
- Back (shoulder blade bone or back muscles)
- Abdomen (belly)
The type of tissue transfer you have depends on the size and location of the primary (main) tumor. The table below shows the most common types of tissue transfers for people with oral cancer.
The donor site is where the tissue is taken from. The recipient site is the part of the mouth the donor tissue rebuilds.
A fibula free flap. An artery, vein, and soft tissue are removed with the fibula bone.
| Type of tissue transfer | Donor site | Recipient site |
|---|---|---|
| Radial forearm flap | Forearm | Tongue or roof of mouth |
| Fibula free flap | Fibula, as well as an artery, vein, and soft tissue | Jawbone |
| Anterolateral thigh flap | Thigh | Tongue |
| Rectus flap | Abdomen | Tongue or roof of mouth |
| Scapula flap | Shoulder blade | Jawbone |
Common questions about mouth cancer surgery
Oral cancer and its treatment can affect how you talk, eat, and drink. Our speech therapists help manage side effects including changes in:
- Speech. You may have trouble saying words, or people have trouble understanding what you’re saying.
- How well you can swallow.
- How well your tongue or jaw can move.
Your speech therapist works with physical and occupational therapists to help care for common problems after treatment. They may recommend exercises to improve your range of motion and muscle strength.
Mouth cancer treatment can affect your digestion (how your body breaks down the food you eat). It can change your taste, how you eat, and how hungry you are.
Our clinical dietitian nutritionists can answer your questions about what you can and should eat. They can help with:
- Planning healthy meals at home.
- Advice about special diets.
- Working around food allergies.
- Managing symptoms such as weight loss or gain
You may have radiation after surgery for oral cancer. Learn more about getting enough nutrition before, during, and after radiation treatment.
Not everyone feels pain the same way. They also do not have pain or discomfort for the same amount of time. In the first days after surgery, you may still have some pain when you go home. Most often, you’ll be taking pain medicine.
After the first week, the pain often gets much better. Most people can stop taking medicine in 3 to 4 weeks.
Some people can have soreness, tightness, or muscle aches around their incision for up to 6 months. This does not mean something is wrong. You’ll have less pain and need less pain medicine as your incision (cut) heals. Your pain level will keep going down after surgery.
You’ll probably see your head and neck surgeon 7 to 10 days after you leave the hospital. If a reconstruction surgeon was involved in your surgery, you will also need to see them.
Based on how you’re healing, they’ll remove some or all of your stitches during your first follow-up visit. You will also have a complete head and neck exam.
If your pathology test results are ready, your surgeon will go over them with you during your first follow-up visit. This includes details about the cancer that was removed.
If you had advanced stage 3 or 4 mouth cancer, you may need radiation therapy, chemotherapy, or both after surgery.
You’ll fully recover from mouth cancer surgery in a few weeks to a few months.
How long it takes to return to your normal life depends on a few things. They include your age and your general health. Recovery time also depends on the type of oral cancer surgery you have.
As you recover:
- The swelling will slowly go away.
- Your face will start to look more natural, and scars will be less noticeable.
- You’ll be able to talk more easily and eat many of the foods you like.
- You’ll have more energy to do the activities you enjoy.
You should see your dentist every 3 to 6 months for cleanings. Talk with your advanced practice provider (APP) before your dental visit. They’re part of your MSK care team and can help you talk with your dentist about your care.
You may need special dental care after treatment. MSK's dental oncologists are doctors trained in dental care and cancer. They treat side effects of mouth cancer therapy, such as:
- Mucositis (myoo-kuh-SIGH-tuhss), or mouth sores.
- Xerostomia (zero-STOW-me-ahh), or dry mouth.
- Tooth decay.
Talk with your APP about your options if you have any mouth side effects.
Trismus is also known as lockjaw. It’s when you have trouble opening your mouth all the way.
After surgery or radiation therapy to your head and neck, your jaw may feel tight. Your mouth may be hard to open.
You can do special exercises to help relax your jaw muscles. This will help your mouth and jaw move and work as they did before your treatment.
Learn more about managing trismus after surgery.
