Head and Neck Surgery
The head and neck contain many complex and interconnected systems that are treated by head and neck surgeons. A head and neck surgeon is a specialist that treats a variety of conditions that include thyroid problems, facial trauma/deformities and head and neck tumors, both benign and malignant.
There are many conditions that can require surgery in the head and neck region, from thyroidectomies to endoscopic removal of pituitary gland tumors to throat and salivary gland tumors. While some surgeries are relatively simple, many are highly complex due to the sensitive nature of this area of the body and its importance in speech, sight, swallowing and even breathing, as well as impacting a patient’s facial appearance. That is why it is important to select a surgeon who is experienced in these types of surgeries.
Endocrine & Salivary Gland Surgery
There are several different types of endocrine glands in the body, each of which secretes specific hormones into the blood stream to be transported to other cells throughout the body to bring about a specific response. These include everything from bone and tissue growth to metabolism, stress response to sleep, mood and sexual function. These glands include the Thyroid, Parathyroid, Adrenal Glands and many more.
Some of the most common endocrine surgeries include the following:
Thyroid Surgery is used to treat several conditions affecting the thyroid gland, a small, butterfly shaped gland in your throat that produces hormones that regulate many important bodily functions, including: metabolism, brain development, heart function, digestion and muscular functionality. There are several conditions that can require thyroid surgery, including Thyroid Cancer, Thyroid Nodules, Hyperthyroidism, Graves’ disease and Goiter. When treating these issues, the surgeon may remove all (total thyroidectomy) or part of the thyroid (lobectomy, with or without an isthmusectomy, removal of the tissue that connects the two lobes of the thyroid). The general rule for deciding how much of the thyroid to remove depends on whether biopsy results indicate cancer prior to surgery. When cancer is indicated, the surgeon generally removes the entire gland. If the diagnosis is not clear, half of the thyroid may be removed in what is known as a lobectomy. However, it is only possible to confirm a benign/malignant diagnosis after the gland is removed and tested. If a lobectomy is done and cancer is diagnosed, a second surgery to remove the rest may be indicated. Whether undergoing a Total thyroidectomy or a thyroid lobectomy, the surgery itself is minimally invasive and performed through the smallest possible incisions in the front of the neck to limit scarring. Patients undergoing this procedure receive general anesthesia, and those having the total thyroidectomy stay in the hospital for one night, while a thyroid lobectomy may be done on an out-patient basis. Patients who have been diagnosed with thyroid cancer will also have some surrounding lymph nodes removed to be examined by the pathologist. Following surgery, patients may experience neck pain or a weak voice, symptoms which are usually temporary. Patients who undergo a total thyroidectomy will need to take thyroid hormone for the rest of their lives. Those who have a lobectomy will need to have their thyroid levels checked to determine if they need to be given thyroid hormone replacement. Possible risks affecting patients after these surgeries include: Injury to the laryngeal nerve causing a hoarse voice, Low blood calcium, and bleeding.
The human body contains four small parathyroid glands, each the size of a grain of rice. They are located behind the thyroid, and their function is to regulate the body’s calcium levels, the most important element in our body. Parathyroid Surgeries are performed to treat conditions that include correcting primary hyperparathyroidism and parathyroid cancer. Prior to surgery, preoperative imaging is done to identify the probable tumor. Then, surgeons use targeted, minimally invasive surgical techniques to operate using small incisions that result in less pain and reduced scarring. Very little other dissection is generally needed. Intra-operative PTH testing may be utilized during surgery, as this is the most accurate way to determine if the disease has been eradicated. Your PTH level is expected to be normal following surgery. The surgery usually takes between 30 minutes and three hours and most patients are able to be discharged the same day. Rare side effects include an injury to the laryngeal nerve that can result in a hoarse voice, however for most patients it is temporary.
Salivary Gland Surgery
The role of salivary glands is to produce saliva in your mouth to aid in digestion, keep your mouth moist and your teeth healthy. There are three major salivary glands that come in pairs (parotid, submandibular & sublingual) and hundreds of minor salivary glands. A partial or complete removal of a salivary gland may be done to treat a blockage, infection or stone or to remove a tumor. The majority of salivary gland tumors occur in the parotid glands (as many as 80% begin here) and about 20% of parotid tumors are cancerous. If a mass is discovered in your parotid gland, often a biopsy is performed to determine if the mass is a cancerous tumor. Imaging tests are also performed to determine the size of the tumor. Even if the tumor is benign, surgery may be required, as these tumors tend to grow and push on surrounding tissue and can even wrap around the facial nerve which passes through the parotid gland. Due to the sensitivity of this area and the fact that this nerve controls movement of your face, this is a delicate surgery. Most parotid tumors start in the superficial lobe of the gland which makes them easier to remove. However, when the tumor originates on the deep lobe or has spread to deeper tissues, the surgery is more difficult, and in the case of cancerous spread, the entire gland may need to be removed in a surgical procedure known as a total parotidectomy. In these cases, other tissues the cancer has affected may also need to be removed. To access the gland, open surgery is generally used. The surgeon makes an incision near the ear and upper neck and removes the tumor, gland and surrounding tissue, while monitoring the facial nerve to help prevent damage. If the nerve has to be cut, a nerve graft may be used. Most patients go home the same day or the next day. Following surgery, a drain may be inserted, in which case patients are instructed on its use and need to record daily output. Within a few days, the drain will be removed at the doctors’ office. There will be some numbness in the cheek and ear following surgery, and that of your ear lobe may be permanent. Some temporary facial weakness can occur after surgery. It is rare for this to be permanent. Another possible side effect of surgery is Frey’s Syndrome, which is when a patient may sweat along their cheek when hungry or eating. This issue requires the attention of your physician.
Another issue of the salivary glands is salivary stones, or sialolithiasis, hardened mineral deposits that form in the salivary glands. Factors that can contribute to their formation include dehydration, smoking, gum disease and trauma to the mouth. Most salivary gland stones form in the submandibular salivary glands. The stones cause swelling and pain, especially when a person is eating or thinking about eating. If the stone blocks the gland duct, it may become infected resulting in a condition called sialadenitis. Most salivary stones resolve through non-surgical treatment, such as applying moist heat, massage or sucking on tart candies to stimulate salivation. However, if these methods don’t resolve the issue, a surgical treatment called a sialendoscopy may become necessary. This procedure requires either local or general anesthesia. A small incision is made near the affected gland through which the surgeon inserts a small tube which they then use as a conduit for other small instruments to remove the stone. If the stone is unusually large, open surgery may become necessary.
Head & Neck Oncology Procedures
When treating head and neck cancers, eliminating the diseased tissue is the primary concern. However, because these cancers occur in an area of the body that can affect quality of life, it’s important to take into consideration how the patient will speak, eat, breathe, look and feel following surgery. Luckily, if caught early, many head and neck cancers can be cured. Surgery is often the best treatment option, though radiation, chemotherapy and targeted therapy may also be used.
Conditions that may require head and neck surgery
Head and neck surgeons operate on the following types of cancerous tumors:
- Oral cancers
- Throat cancers
- Salivary gland tumors
- Tumors in the nasal cavities and sinuses
- Tumors in the parathyroid
- Laryngeal cancer
- Complex skin cancers
At Center for Advanced Surgical Oncology, we treat the entire spectrum of cancers and cancer related disorders. Our experienced team of caring professionals offer advanced surgical treatment options. Dealing with cancer can be difficult, but at Center for Advanced Surgical Oncology, we are here for you every step of the way.
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Rodrigo Arrangoiz, MD, MS, FACS