Page 18 - Head and neck surgery

Definitive surgery is offered as first-line treatment in patients with advanced disease at

presentation e.g. those presenting with non-functioning larynx whereby the benefits of laryngeal

preservation associated with chemoradiotherapy is obsolete.

Although chemoradiotherapy enables laryngeal preservation, this does not always equate

functional preservation – patients with more advanced tumour may suffer from laryngeal

oedema, decreased supraglottic sensation and recurrent laryngeal nerve injury, rendering a

portion of patients at risk of aspiration and hence tracheostomy tube +/- feeding tube dependent

i.e. losing the ability to eat and speak. Definitive surgery should be offered in this group of

patients.

Surgery can also be offered as a means of salvage for those with persistent disease after

chemoradiotherapy and / or recurrent disease after chemoradiotherapy +/- surgery.