This is the fourth and final article in Pain.com’s series for Oral Cancer Awareness Month. This article gives an overview of restoration and rehabilitation in patients with oral cancer.
In performing oral cancer surgery, surgeons are always looking to remove all of the cancerous cells, but minimize damage to healthy tissues in the mouth to preserve function and appearance. However, it is sometimes necessary to remove a portion of a jaw, or part of the hard or soft palate, for example, in order to treat the cancer. Patients may need to have restorative procedures for functional or cosmetic reasons after oral cancer surgery. Restoration refers to surgical procedures that help reconstruct the areas of the oral cavity that have been surgically altered when the oral cancer was removed. Sometimes, these procedures are done after treatment for oral cancer is completed, but some procedures may be performed at the same time that the cancer is surgically removed. Restorative procedures may involve bone reconstruction or soft tissue reconstruction, depending on the location and extent of the cancer.
If part of the jaw must be removed, the loss of teeth can impact function in an oral cancer patient. The patient may require dental prosthetics, or dentures, for functional and cosmetic reasons. If only a few teeth are missing, partial dentures are used. If a patient is missing all of the teeth in one or both jaws, a full set of dentures is necessary. In some cases, non-removable dental implants are used.
Extensive facial reconstruction may sometimes be necessary in advanced cases of oral cancer. Some of this restoration can be accomplished surgically, but for larger defects, it is often a better choice to opt for prosthetic options. The goal of facial prosthetics is to replace tissue that has been lost as inconspicuously as possible.
Rehabilitation encompasses things like speech therapy and occupational therapy. Some people have some difficulty with speech after oral cancer surgery that may be helped with speech therapy and possibly with prosthetic devices. A person who has had oral cancer surgery may also have difficulty chewing, controlling salivation or swallowing. These patients may benefit from occupational therapy, prosthetic devices and possibly consultations with a dietitian, who can give advice about how to get adequate nutrition if they are having problems eating certain types of food. Oral cancer patients are especially at risk for malnutrition, because of surgery-related oral disabilities and the side effects of radiation therapy and possibly chemotherapy.
About a week after surgery, the patient may need to undergo therapy to teach them how to swallow normally. This makes eating and drinking easier, plus it reduces the chances that the patient will aspirate liquids into the lungs. A patient who is having difficulty swallowing and eating may need to have a diet of soft foods and pureed foods, or alternate bites of solid foods and liquid foods. The goal is to get the patient to be able to obtain adequate nutrition by mouth, and not have to rely on alternate methods of obtaining nutrition, like feeding tubes.
Before even starting cancer treatment, the medical team keeps in mind the goal of retaining as much function and appearance as possible in the patient. The ultimate goals of restoration and rehabilitation in oral cancer patients are always to try to return the patient to a normal level of functioning. This is not always possible, and the patient and their loved ones must have realistic expectations; however, great improvements can be made. The restoration and rehabilitation process for patients with oral cancer must be personalized to each case. The patient may need to see a team of doctors and specialists in order to accomplish a successful rehabilitation.