Dentist, surgeon begins new era in treating head and neck cancers
David R. Kang, M.D., D.D.S., assistant professor in oral and maxillofacial surgery, joined Texas A&M University Baylor College of Dentistry as its first head and neck oncologic and microvascular reconstructive surgeon. His job description is complex, but the meaning isn’t lost on patients with oral cancer facing the reality of surgery.
This dual-trained dentist and physician spent an additional year after his oral and maxillofacial surgery residency to complete a fellowship in head and neck oncologic surgery at the University of Michigan. He returned to Dallas with the in-depth training he needed to not only remove cancerous head and neck tumors but to also reconstruct the entire surgical area with free tissue transfer– providing a critical step in a patient’s return to normalcy following a life-altering diagnosis and treatment.
A multidisciplinary approach to caring for cancer patients is required with various specialists involved in their treatment including radiation oncologists, medical oncologists, pathologists, maxillofacial prosthodontics, anaplastologists, speech therapists, physical therapists and occupational therapists who also specialize in the management of lymphedema.
“Our patients are frequently presented to the Head and Neck Tumor Board, which meets twice a month to discuss treatment options including surgery, radiation therapy and chemotherapy,” Kang said.
Many of the patients Kang treats are dealing with the side effects of radiation – a treatment that, while often effective at combating cancer, is notorious for wreaking havoc on the healthy areas of the body through which it passes. He takes special steps to ensure that his patients’ reconstructions hold up to the radiation that may occur post-surgery.
“In the past, post-surgery radiation treatment led to a decreased quality of life,” Kang said. “But now, with intensity modulated radiation therapy (IMRT), and the ability to harvest vascularized tissue from any area on the patient’s body, we can tailor the reconstruction to the patient’s needs.”
This free tissue transfer approach—or free flap—returns form and function to the patient by using skin, fascia, muscle, nerve or bone tissue to reconstruct any defect, regardless of the size. After microvascular anastomosis, where vessels sometimes less than one millimeter in size are sutured together, the procedure provides immediate blood flow to the reconstructed tissue and allows the surgical site to heal rapidly, allowing patients to begin radiation treatment within four to six weeks. The free flap approach, Kang notes, has become the gold standard in reconstruction of the oral cavity.
In the short time Kang has been at Texas A&M Baylor College of Dentistry, he and his team have treated hundreds of patients with malignant disease as well as trauma, but especially those patients with squamous cell carcinoma. He has also successfully treated extremely rare tumors such as adenoid cystic carcinoma, ameloblastic carcinoma, and mucosal melanomas, not only removing the tumors, but successfully restoring facial aesthetics and function to the oral cavity. While the free flap procedure is impressive, it may not be the ideal choice for all patients, Kang says. With longer operating and hospitalization times, it can be an additional risk for patients with medical comorbidities.
“When a less invasive option is in order for maxillary defects, we will often opt for placement of an obturator, which is very similar to a denture and closes off the defect and restores facial contour,” Kang said. “As with any treatment, we work in collaboration with other health care professionals to find the best treatment plan possible for each individual patient.”