Free Flap Surgery and Oncologic Care of the Pregnant Head and Neck Cancer Patient

Background: Although head and neck cancer (HNC) in pregnant patients is rare, the incidence of oral cavity cancer has increased in younger women of childbearing age. We detail the complexities of two cases of HNC during pregnancy requiring surgical resection with free flap reconstruction, followed by general guidelines for HNC care of this population. Methods: We report two cases of head and neck cancer management in the pregnant patient. Results: Both patients underwent similar free flap reconstruction for oral cavity cancer. One was able to avoid adjuvant and deliver a healthy child at term, while the second required early termination followed by chemotherapy and radiation. Both remain disease free. Conclusions: Multidisciplinary management is crucial in care for the pregnant HNC patient. Goals include cumulative radiation dose exposures below 100 mGy, operating in the second trimester when the risk is lowest to the fetus and mother, and avoiding chemotherapy or radiation in the first trimester when possible.