Is nicotine still the bad guy? Summary of the effects of smoking on patients with head and neck cancer in the postoperative period and the uses of nicotine replacement therapy in these patients.

Smoking has long been implicated in the development and progression of numerous postoperative complications. The cause is largely thought to be the presence of reactive oxygen species (ROS) in cigarette smoke, which attenuates inflammation and affects neutrophil function. Wound healing is further compromised by deficiencies in vitamins C and E, which result from a higher vitamin turnover secondary to the oxidative stress produced by smoking. However, studies recently have found that the effects of nicotine may benefit healing if used in isolation. We summarise the effects that smoking and abstaining from smoking can have on inflammation and wound healing, and describe the possible benefits that nicotine replacement and antioxidant supplements can give.