Head and Neck Surgery

Thyroid nodules

The thyroid gland is a very important endocrine gland that produces a hormone that is necessary for normal body metabolism and function. It is located just below the voice box and in front of the windpipe. The thyroid may contain cysts, nodules or tumors. Thyroid cancer may be difficult to distinguish from benign tumors or nodules. A thyroid ultrasound is a noninvasive imaging study to determine cysts from nodules or tumors. A fine needle aspiration (FNA) is a minimally invasive way to biopsy nodules. Observation or surgery may be recommended depending on the results.

Parathyroid disorder

There are four parathyroid glands, normally the size of a pea, located on the backside of the thyroid gland. These important glands secrete parathyroid hormone (PTH), which regulates calcium metabolism in our body. If one or more of these are overactive the calcium level may be high resulting in kidney stones or osteoporosis (brittle bones). A blood test and imaging are required to make a diagnosis. Surgery may be necessary to remove the overactive gland(s).

Neck masses

A neck mass or growth may be due to an enlarged lymph node, cyst, tumor or cancer. Inflammatory lymph nodes should subside after an infection. A persistent or enlarging mass, even if painless, should raise suspicion and be evaluated. An ENT doctor is uniquely qualified to investigate this condition. There are many hidden areas in the nose and throat that need to be examined to understand the nature of a neck mass. Always start with a thorough ENT evaluation before having any kind of biopsy or surgery.

Head and neck cancer

Cancers of the head and neck may have many presentations. Ongoing symptoms that don’t resolve in 4-6 weeks such as sore throat, difficulty swallowing, cough, ear pain, voice change, a growth in the mouth or throat or neck mass require prompt evaluation. Smoking and tobacco use, alcohol consumption and human papilloma virus (HPV) are risk factors for getting these kinds of cancers. Even patients without these risk factors are capable of getting these dangerous cancers. A complete head and neck evaluation by an ENT physician is the first place to start. Imaging such as CT or MRI and blood work are needed to fully work up this problem before a biopsy or treatment is recommended.

Skin cancer

Skin cancer is increasing every year despite warnings to protect ourselves from the sun. Years of sun exposure to the head and neck may result in sores that do not heal or lesions that do not resolve. Bleeding, itching or non-healing sores, and moles that are changing in color or size should be evaluated. A biopsy may be necessary to determine if the problem is benign or one of three common skin cancers – basal cell, squamous cell or melanoma. Treatment will depend on the type of cancer and location in the head and neck.

Salivary gland infection and tumors

There are two major salivary glands on each side of the face and neck. The parotid gland is located on the back part of our cheeks in front of the ears and the submandibular gland lies under our jaw.

Like many other organs these can become infected or develop tumors which may be benign or malignant. Small stones may obstruct the ducts that drain saliva into the mouth resulting in painful swelling. This often clears with antibiotics and may require removal of the stone. Surgery to remove the gland is reserved for recurrent infections or tumors.

Procedures and Treatment

Thyroidectomy

Thyroid surgery is indicated for suspicious nodules or tumors, an overactive gland that can’t be regulated with medication or radioactive iodine treatment, and when the gland is enlarging resulting in difficulty swallowing or breathing. Many times only half of the gland is removed to manage nodules or tumors. If malignancy is found then additional surgery to remove the other side is often recommended. Thyroid malignancy appears to be on the rise. New treatment protocols are evolving to mange this problem.

Parathyroidectomy

Overactive parathyroid function results in elevated calcium levels, which may result in kidney stones, osteoporosis, confusion and a host of other problems. More than 80% of the time this is due to one (adenoma) of four glands that is enlarged and hyperactive. Other times there may be two or more involved glands. There are several imaging tests that help localize the involved gland so surgery may be targeted to the correct site.

Excision of neck mass

Many different types of growths, cysts and tumors can develop in the neck. These arise from the skin or underlying soft tissues, fat, muscle and blood vessels. The size and location determine whether they can be removed under local anesthetic or general anesthesia. Incisions are designed and planned to lie in natural skin creases and folds to maximize cosmetic results.

Lymph node biopsy

There are many naturally occurring lymph nodes in the head and neck. These are connected by small channels much like our circulation and transport a fluid called lymph. This system is part of our immune system and responds to inflammation, infection and malignancy. Persistent or enlarging lymph nodes that do not resolve need to be investigated. This may include needle biopsy but sometimes require surgical biopsy to establish a diagnosis. Lymph node biopsy is an outpatient procedure.

Skin cancer surgery and reconstruction

Many small skin cancers can be successfully treated by cryosurgery or freezing. Recurrent or larger skin cancers often need surgery to remove the lesion in order to get clear surgical margins. Surrounding skin and underlying soft tissue has to be removed to insure complete removal. This is very important so residual cancer cells are not left behind only to grow into another lesion. The surgical defect after removing the involved skin and soft tissue has to be closed. This may require transferring adjacent skin or using skin grafts.

Excision of salivary gland

There are many small glands that produce saliva to moisten the mouth and lubricate food we swallow. The parotid and submandibular glands are much larger and contribute to this function as well. These glands may get obstructed from dehydration or small stones. Recurrent salivary gland infection is one indication to remove the gland. Benign and malignant tumors may develop and is another indication for surgery. There are many nerves and blood vessels associated with these glands so precise and delicate surgical technique is required.