HEAD AND NECK CANCER

The first step in treating head and neck cancer is to determine the stage of the cancer.

Stage I and II cancers are small and haven’t spread from their original location. They are usually curable.

Stage III and IV cancers usually spread to nearby lymph nodes, and/or are large tumors. They usually require more complicated treatment and have a smaller chance of cure, but most are potentially curable. Tumors that have spread to other parts of the body, called metastatic tumors, are generally thought to be incurable but may be treated to reduce symptoms.

The stage, along with your age, general health, and location of the tumor, will determine your treatment plan.

The three main courses of treatment for head and neck cancers are radiation therapy, surgery, and chemotherapy. Some patients may receive all three treatments.

• Surgery: Surgeons may remove the tumor and a margin of surrounding healthy tissue. Lymph nodes in the neck may also be removed if it’s suspected that cancer has spread. Surgery on the head and neck areas may change the patient’s appearance and ability to chew, talk and swallow. For these reasons, patients may require reconstructive surgery and speech therapy after surgery.

• Radiation therapy: This involves the use of high-energy X-rays to kill cancer cells. This is done via a machine near the body. Radiation therapy can have side effects, such as sores or irritation in the treated area, difficulty in swallowing or tasting, loss of saliva, decreased appetite, and nausea. Tell your provider of any side effects for guidance on how to best deal with them.

• Chemotherapy: Chemo is the use of anti-cancer drugs to kill cancer cells throughout the body. It’s more commonly used for advanced-stage head and neck cancers. Side effects include sores in the mouth, loss of appetite, nausea, vomiting, tiredness, rash, joint pain, and hair loss. Talk to your provider about how to treat these side effects.

 

 

 

 

 

 

 

 

 

 

 

 

THYROID SURGERY:

The thyroid is a butterfly-shaped gland located in front of your neck just below the voice box (larynx). Thyroid surgery involves the removal of part or the whole thyroid gland.

The thyroid gland secretes thyroid hormones (TH) that regulate metabolism, growth, and development of the human body. It influences the normal functioning of vital organs such as the liver, brain, heart, kidneys, and skin.

Thyroid Surgery is required  for certain thyroid problems like: Thyroid cancer, hyperthyroidism, fluid-filled thyroid nodules causing difficulty in swallowing or breathing and massive goiter compressing the trachea and esophagus. Untreated thyroid disorders can cause complications such as muscle weakness, tremors, menstrual and fertility problems, heart and kidney diseases.

Thyroid surgery is usually performed by an open incision of 3-4 inches. Minimally invasive surgery can be performed in some patients. The surgery involves the following steps:

• You will be given general anesthesia and your surgeon will perform a cervical nerve block.

• A breathing tube can be placed to help you breathe during surgery.

• A small incision will be made in your neck region. Care is taken to avoid damage of vocal cords, trachea and nearby nerves.

• Depending on the condition, either type of surgery will be performed:

  • Hemithyroidectomy or Lobectomy: Removal of a part or half of the thyroid gland.

  • Isthmusectomy: Removal of the isthmus, a small part of the thyroid gland that connects the right lobe to the left lobe.

  • Total Thyroidectomy: Removal of the entire thyroid gland.

• A nearby lymph node will be removed if thyroid cancer has spread beyond the gland.

• The incision is closed with sutures or protective strip of surgical glue called collodion.

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THYROIDECTOMY

Thyroid cancer is an abnormal growth of the cells of the thyroid gland. Thyroid gland secretes hormones that help regulate the body’s metabolism and levels of calcium. People who are exposed to high levels of radiation to the neck and have a family history of thyroid cancer and goiter (enlargement of thyroid gland) are at a higher risk of developing thyroid cancer.

Surgical Procedure 

Generally, surgery involving thyroid gland removal is the most common treatment of thyroid cancer. Total thyroidectomy is a surgical procedure to remove all of the thyroid glands. Subtotal or partial thyroidectomy is a surgery to remove part of the thyroid gland. Your doctor may also remove the lymph nodes if the cancer has spread to the lymph nodes. The surgery is performed under general anesthesia. The surgeon removes the thyroid gland by making a 3-inch to 4-inch incision in the middle of your neck, on top of the thyroid gland. A small tube (catheter) will be placed into the area to drain the accumulated blood and fluids.

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THYROID AND NECK BIOPSIES

A biopsy is a diagnostic procedure in which a tissue sample is removed from the thyroid gland/ Neck and examined for infection and cancer. Biopsy can be carried out under local or general anesthesia depending upon the procedure.

• Ultrasound-guided thyroid fine-needle aspiration biopsy is performed under ultrasound guidance to facilitate the identification of the suspicious tissue lesion and accurate placement of the biopsy needle. Gel is applied on the skin over the thyroid gland and an ultrasound transducer is glided over the region. Guided by the ultrasound images, your radiologist inserts the biopsy needle into the gland and removes a sample of tissue.

• Core needle biopsy: Core needle biopsy uses a wider needle that allows the extraction of a core of tissue through its hollow needle tube.

• Open biopsy: Open biopsy is a surgical procedure where a small incision is made in your neck to access the thyroid gland and remove a sample of tissue or lump. The incisions are then closed with stitches.

The tissue sample collected by any of these methods is sent to the laboratory for examination of abnormalities. Your treatment will be based on the results of the laboratory findings.

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SINUS SURGERY:

Sinusitis is defined as inflammation of the paranasal sinus cavities and can be caused by infection with viruses, bacteria, or fungi, or chronic irritation from allergies. Sinusitis can be classified as acute (symptoms less than 4 weeks), subacute (symptoms between 4 and 8 weeks), or chronic (symptoms lasting more than 8 weeks). When inflammation is present, the openings of the sinuses can be blocked leading to trapped secretions in the sinuses. The secretions become infected, leading to pain, pressure, and feeling of malaise that accompanies sinusitis.

Functional endoscopic sinus surgery (FESS) is an option for  patients who suffer from sinusitis and have had inadequate relief from medications.  It removes diseased areas from the sinuses and create stable openings that allow better drainage. Medications may also work more effectively after the sinuses have been opened. The surgery is most commonly performed in the outpatient setting under general anesthesia. It usually takes between one to three hours and patients typically go home afterwards. Depending on the extent of surgery, recovery can take several days to one week before returning to work or school. There are no incisions on the face, rather the surgery is performed through the nostrils with tiny cameras and instruments.

For some patients with sinusitis, a newer technology known as Balloon Sinuplasty may be an option. This is a minimally invasive procedure that is now commonly performed in the office setting with local anesthesia. Using a tiny camera in the nose, the surgeon is able to thread a balloon into the sinus opening. As the balloon is inflated with water, the sinus opening is dilated to allow for improved drainage and aeration. Studies have shown high levels of patient satisfaction with Balloon Sinuplasty, with the added benefit of minimal or no downtime.

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SALIVARY GLAND SURGERY

The purpose of saliva is to moisten the mouth, protect the teeth against bacteria and aid in the digestive process. When tumors occur on the salivary glands, surgery is the most commonly recommended course of treatment.

The parotid glands are the largest salivary glands and are found on either side of the face just in front of the ears. These glands produce saliva that is secreted through the ducts into the mouth. The submandibular glands are located a little below the mandible or jaw bone. Its secretions enter the oral cavity through the floor of the mouth. The sublingual glands on either side of the tongue are the smallest of the three glands. These glands empty the secretions through the floor of the mouth as well.

Cysts or tumors leading to blockage or infection of any of these ducts is the most common cause of salivary gland problems. The symptoms include fever, pain, lump or swelling, dry mouth or a bad taste in the mouth. These symptoms are initially treated with conservative measures. Surgery is recommended however if the symptoms do not respond to conservative treatment.

Surgical Procedure

• Salivary gland surgery is usually carried out under general anesthesia. Surgery to the parotid gland is performed by making an incision in front of the ear that extends slightly down the neck.

• The parotid is divided into a superficial and deep lobe. The facial nerve usually runs in between these two lobes.

• Care is taken to minimize injury to this nerve and its function may be monitored during the operation. If detected early, a tumor may be limited to the superficial lobe and only that lobe is removed preserving most or all of the facial nerve.

• For malignant or deep tumors, the entire gland is removed and a portion of the facial nerve may need to be sacrificed.

• Surrounding structures involved by cancer may also have to be removed. The excised portion or gland is sent to a pathologist for examination.

• Removal of the submandibular salivary gland is carried out by making a 2-inch incision below the lower jaw.

• Branches of the facial nerve running near the gland are protected as far as possible during surgery. Sublingual gland surgery is usually performed through an oral approach.

• Salivary gland surgery usually takes about 45 minutes to perform depending on the complexity.

• You may require an overnight hospital stay following the procedure.

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COCHLEAR IMPLANTATION:

Cochlear implantation is a procedure for the treatment of severe to profound sensorineural hearing loss (SNHL) in both children and adults. A cochlear implant is a device inserted into your ear to help in hearing. Although it cannot restore hearing completely, it does restore the sensation of sound. It works by stimulating the auditory nerve, the nerve that carries sound impulses to the brain. Cochlear implants are indicated for the profoundly or totally deaf, who have either been born deaf or have lost hearing later in life.

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