Surgery for Head and Neck Cancer
Principles
Surgical questions reward understanding of margins, reconstruction, and functional consequences. Know that oncologic resection aims for clear margins (commonly described in millimeters, with frozen section assessment), and that margin status is a dominant prognostic factor. Understand neck dissection types: radical (levels I–V plus nonlymphatic structures), modified radical (spares structures), selective (specific levels based on primary), and extended. Know when elective neck dissection is indicated (risk of occult metastasis above a threshold, typically deep invasion or certain sites).
Reconstruction and function
Understand the reconstructive ladder and the role of free flaps (e.g., radial forearm, fibula) for complex defects, and that reconstruction aims to restore swallowing, speech, and cosmesis. Know that tracheostomy and feeding tube decisions are part of the surgical plan and have survivorship implications.
Traps
Common traps: confusing selective versus modified radical neck dissection definitions; assuming a "negative" clinical neck excludes occult disease; and forgetting that margin status is reported on the final specimen even when frozen section was negative. Another trap is overlooking the functional trade-off of a given resection.
Rule of thumb
For any surgical item, identify the defect, the reconstructive option, and the functional consequence. Example: a composite mandibular defect after segmental resection typically needs bony reconstruction (e.g., fibula free flap) to restore contour and allow dental rehabilitation, not just soft tissue coverage-choosing soft tissue alone is a classic wrong answer.