Exciting new developments in upper-jaw reconstructive surgery

Prof Richard Shaw - University of Liverpool Cancer Research Centre, Liverpool, UK

Can you describe the recent developments in upper jaw reconstructive surgery?

Liverpool has been an innovative and ground-breaking unit for developing surgical reconstruction in head and neck cancer for a number of years. Through my predecessors, David Vaughan and James Brown, I’ve now stepped into the role and we offer what we think is cutting edge reconstruction. Where patients in the past would often have upper jaw tumours removed and merely replaced with an extension to a denture, so that’s called an obturator, a lot of patients didn’t really like that and long term survivors found it quite difficult for their quality of life and speech and swallowing. So one thing we’ve been advocating for years is to reconstruct the defect with what we call a free flap, so it’s vascularised tissue from elsewhere in the body and actually to reconstruct with bone and then to build the teeth on dental implants. So that hasn’t been a common treatment up until recently in many parts of the world and it is technically complex but we feel that the benefits to the patient of offering them full rehabilitation start with the initial treatment planning and they start with the day that the tumour is removed. So my lecture really addresses that and the Liverpool unit has been asked to host a session on reconstruction with a Toronto unit and to talk about the various methods of reconstruction.

What are the cost implications?

The costs are there and the operations to offer simultaneous removal of the tumour and reconstruction with a composite flap will be in the realms of 10-12 hours. So that is a substantial cost and often a two team approach so you’ve got at least two surgical teams and sometimes the input of a dental specialist as well. So I’m sure the costs are there, put against the costs of complex drug treatment they’re more or less equivalent.