Dr. Dr. Christoph Pytlik, M.Sc., is a highly qualified specialist in oral and maxillofacial surgery with extensive expertise in the fields of implantology and aesthetic surgery. With his in-depth training and many years of experience, he is one of the leading experts in these fields. His practices in Bielefeld and Detmold are among the most modern facilities for oral and maxillofacial surgery in the region and offer a wide range of surgical services. These include implantology, dentoalveolar surgery, the treatment of jaw and facial fractures, and plastic and aesthetic surgery.
In the field of implantology, Dr. Dr. Pytlik holds special qualifications, including a Master of Science in Oral Implantology, which underscores his in-depth expertise in the planning and execution of implant procedures. By utilizing state-of-the-art technologies, such as 3D planning and simulation, he is able to prepare procedures with precision and provide patients with a detailed overview of the planned course of treatment. In addition, Dr. Dr. Pytlik covers the entire field of oral and maxillofacial surgery. A key focus of his practice is the treatment of midface and jaw fractures, which, due to their complexity, require a high degree of surgical precision.
Dr. Dr. Pytlik plays a key role in the Head and Neck Tumor Center and the Skull Base Center at the Bielefeld Municipal Hospital, where he serves as the lead surgeon for oral cavity carcinomas. Working closely with the ENT department and the plastic surgery department, he performs complex tumor surgeries in the head and neck region there. This facility, which is certified by OnkoZert, offers highly specialized, interdisciplinary care of the highest standard, recognized far beyond the region.
A distinctive feature of Dr. Dr. Pytlik’s work is the interdisciplinary collaboration at the new medical center of excellence in the Seidensticker Kontor in Bielefeld, which opened in June 2024. This center brings together various highly specialized disciplines, including otolaryngology and dermatology, under one roof. In this innovative setting, Dr. Dr. Pytlik is responsible for the field of oral and maxillofacial surgery and provides his patients with comprehensive and holistic care.
In addition to his clinical work, Dr. Dr. Pytlik is deeply involved in research and teaching. In cooperation with the newly founded OWL Medical Faculty at Bielefeld University, he is helping to expand the Head and Neck Tumor Center and supports the training of future medical professionals. His scientific work and his contributions to the advancement of surgery, particularly in the field of tumor treatment, make him a valued resource for colleagues and students alike. At his practices in Bielefeld and Detmold, Dr. Dr. Pytlik places great emphasis on personalized care and state-of-the-art technology to provide his patients with the best possible care.
The editorial team of the Leading Medicine Guide spoke with Dr. Dr. Pytlik, focusing on ensuring masticatory function in cancer patients—one of the specialist’s areas of expertise.
Masticatory function is a central ability of the human body that enables the breaking down and chewing of food, thereby playing a crucial role in digestion and nutrient intake. It is controlled by the interaction of the teeth, jaw muscles, temporomandibular joints, and the nervous system. Disorders of masticatory function—such as those caused by tooth loss, malocclusion, or disease—can have significant effects on nutrition and overall well-being. In cancer patients, particularly those with tumors in the head and neck region, masticatory function can be significantly impaired. Tumors in the oral cavity, on the jaw, or in the throat, as well as their surgical removal, radiation therapy, or chemotherapy, can disrupt the complex interaction between the teeth, jaw muscles, and nerves. This often leads to difficulties with chewing, swallowing, and speaking. Changes in chewing function affect not only food intake but also the quality of life of those affected. Targeted rehabilitation and therapy are therefore essential to provide patients with the best possible support and to restore chewing function.
Tumors in the head and neck region that most commonly impair masticatory function include oral cavity carcinomas, tongue cancer, pharyngeal cancer, salivary gland tumors, and tumors of the jawbone.
“The basic principle of any tumor surgery is that, after staging has been completed, the patient is presented to a tumor board. During staging, imaging is performed of the floor of the mouth, neck, thorax, and abdomen to check whether metastasis is already present. The tumor board then collaboratively determines the final course of treatment for the patient,” explains Dr. Dr. Pytlik, adding:
“Especially in cases of oral cavity carcinomas, surgical therapy aimed at R0 resection (complete removal of the tumor) is crucial. To verify this, intraoperative frozen sections and tissue samples are examined pathologically during the operation itself. The pathologist then determines whether the tumor could be removed ‘in sano.’ This means that the tissue sample or surgical removal of the tumor was performed within healthy tissue—that is, with a sufficient safety margin from pathologically altered tissue. The potential impairments the patient may experience—particularly with regard to chewing, speech, and swallowing functions—depend on this level of precision. This requires walking a fine line: no tumor tissue may be left behind, even if this means that important nerves must be compromised or removed. In cases of extensive tumors, the impairments for the patient tend to be greater, as it is often not possible to spare soft tissue, muscles, or nerves. If motor nerves such as the hypoglossal nerve (responsible for tongue movement) are removed, the tongue loses its mobility on at least one side. Similarly, removal of the tongue’s sensory nerve—which transmits both taste sensations as well as sensations of touch and pain—leads to a complete loss of these functions. Therefore, precise preoperative planning within the tumor board is essential. In addition, surgical treatment requires the highest level of expertise to optimally remove the tumor and ensure the patient’s quality of life. This careful planning and execution is crucial for the long-term survival of patients.”
Tumors in the head and neck region directly affect the mechanisms of mastication by invading muscles, nerves, and bones. The effects can range from mild limitations in mobility to complete loss of function, necessitating tailored therapeutic treatment and often complex reconstructive procedures.
Surgical procedures to remove tumors in the jaw and oral cavity can significantly impair masticatory function, as they often lead to structural changes and loss of function.
“Surgery for so-called T4 carcinomas (advanced tumors in the oral cavity) often affects important anatomical structures such as bones, muscles, nerves, and soft tissues that are crucial for the masticatory process. The loss of jawbone, for example due to the resection of tumorous tissue, can lead to an unstable or asymmetrical jaw structure, which makes chewing and biting considerably more difficult. Similarly, procedures on the masticatory muscles—which are often necessary to remove tumors—can weaken the muscles and restrict jaw mobility, a condition known as trismus. This restriction not only impairs jaw movement but also reduces chewing force. “The more tissue we have to remove, the more we must focus on tissue replacement,” explains Dr. Dr. Pytlik, outlining the next steps:
“When operating on larger tumors, we always perform primary reconstruction. This is done using soft tissue—more specifically, microvascular tissue grafts, for example from the forearm or lower leg—which can be used to primarily reconstruct the defect. This was not possible 30 years ago, with the result that the patient suffered a massive impairment of chewing function. And even when tumors infiltrate the lower jaw, we perform jaw replacement here as well—for example, using a piece of the fibula—which is crucial for the primary restoration of the jaw. “Our goal is to rehabilitate the patient—taking the tumor’s size into account—in a way that preserves their quality of life.”
T4 carcinomas in the oral cavity are advanced tumors that have spread beyond their original site. These tumors are aggressive, often cause pain and difficulty swallowing, and require intensive treatment with surgery, chemotherapy, and radiation therapy. Due to their advanced spread, T4 tumors have a poorer prognosis.
Preoperative 3D planning makes it possible to precisely simulate and plan the procedure in order to spare healthy tissue. Using state-of-the-art technologies, such as 3D-printed models, custom-fit implants can be created for jaw reconstruction. Intraoperative radiation therapy can also be used to directly target the tumor during surgery while sparing the surrounding tissue. Through a combination of reconstructive, nerve-sparing, and preventive measures, it is possible to preserve or restore chewing function to the greatest extent possible following tumor surgery. Interdisciplinary collaboration between surgeons, oncologists, prosthodontists, and rehabilitation specialists—along with the highest level of expertise—is crucial to ensuring the best possible functional and aesthetic care for patients.
“In some cases, reconstruction is not possible. If the patient is in poor overall health, they may not be able to withstand reconstructive surgery, which can sometimes take 6–8 hours. However, thanks to collaboration with the Department of Plastic Surgery, this surgical time is already significantly shorter than it used to be, when such procedures were not performed in a collaborative setting. For patients who are not candidates for surgery, radiation therapy, chemotherapy, or immunotherapy is considered instead. This decision is made in the tumor board together with experienced colleagues to ensure the best possible treatment for the patient,” explains Dr. Dr. Pytlik, describing the greatest challenge:
“The biggest challenge is always to perform the surgery in such a way that the tumor is completely removed. This depends largely on the surgical approaches and the size of the tumor. Larger tumors require special surgical approaches, which can be created, for example, by temporarily severing the lower jaw. A tumor must always be resected three-dimensionally via a primary access route to achieve an R0 resection. The exact extent of the tumor is analyzed in detail prior to surgery as part of preoperative diagnostics and the tumor board. Ultimately, the goal of the surgery is to remove the tumor along with healthy tissue to prevent recurrence.”
Restoring chewing function after tumor treatment requires a comprehensive and targeted rehabilitation program tailored to the patient’s individual needs.
Interdisciplinary collaboration between surgeons, speech-language pathologists, physical therapists, and dental technicians plays a crucial role in this process. Close communication among these specialties makes it possible to develop a comprehensive treatment plan that takes into account both medical and rehabilitative aspects.
“Even after surgery, the patient is presented to the tumor board—not in person, but based on their medical data and the pathohistological findings. Based on this information, a decision is made as to whether postoperative chemoradiotherapy is necessary, depending on how close the resection was to the tumor margins and the tumor’s location in millimeters. If radiation therapy is necessary, we organize the process so that the patient’s masticatory function is restored as soon as possible afterward. We consider aesthetic and functional restoration from an early stage. It’s also important to note that many patients have poor dental health due to their condition. Therefore, we perform dental restoration before surgery to eliminate the risk of infection during the procedure. As part of functional rehabilitation, the patient receives an implant-supported prosthesis. This is particularly important because radiation therapy often causes side effects such as dry mouth, scarring, and limited mouth opening. “A poorly fitting prosthesis could contribute to soft tissue and bone dysfunction and, in the worst case, trigger osteoradionecrosis (a disorder of the lower jawbone),” explains Dr. Dr. Pytlik.
At the Bielefeld Head and Neck Center, 30–50 major surgeries involving microvascular reconstruction are performed each year.
Successful Rehabilitation After Tumor Surgery: Time, Patience, and Interdisciplinary Care
“A full return to daily life depends largely on the size of the tumor. If necessary, a tracheotomy is performed during surgery, which can lead to unpredictable swelling postoperatively. In addition, a PEK (percutaneous endoscopic colostomy) feeding tube is inserted. This allows liquid food, medication, or water to be delivered directly into the stomach or small intestine and is used primarily for long-term artificial feeding. “The goal is to keep this necessity as short as possible in order to restore normal chewing function as quickly as possible. Nevertheless, it should be expected to take about a year for the patient to fully reintegrate into daily life, as the tissue needs time to heal,” explains Dr. Dr. Pytlik, emphasizing:
“In Bielefeld, we are very well-equipped for this and work quickly, with an implant failure rate that is virtually negligible. Patients are usually relieved when the feeding tube is removed and they can bite and chew again. This process is supported by speech-language pathologists, who train tongue function, as well as by physical therapists, who work on the initially limited mouth opening. The long-term prognosis also depends on the tumor size and the patients’ lifestyle habits. Adverse factors such as smoking or alcohol consumption generally promote tumor growth. If these are reduced, the success rate increases. We monitor patients for life—quarterly during the first year—and perform regular CT and MRI scans to ensure the absence of tumor. Our expertise in microvascular reconstruction is particularly noteworthy. Nevertheless, one thing remains clear: Not every patient can be given a chance at survival, regardless of who performs the surgery.”
Dentists as the Key to Early Detection of Oral Tumors
“A crucial factor and important link is the dentist, who performs the initial oral examination. After all, they are the first to examine patients’ oral cavities—for example, during filling procedures—and, in cases of doubt, can detect a tumor through visual examination and refer the patient to us. We have a mucosal clinic in Bielefeld where we also monitor other benign mucosal conditions. This collaboration with dentists works very well here,” states Dr. Dr. Pytlik, adding this advice at the end of our conversation: “Please go to the dentist! Not only to keep your teeth healthy, but also to detect oral mucosal diseases.”
Thank you very much, Dr. Dr. Pytlik, for this informative conversation!
