Head and Neck Surgery

Head and Neck Cancers

Head and neck cancers often arise after prolonged exposure to specific factors such as tobacco, alcoholic beverages, and sunlight.   Although the following signs and symptoms can occur when no cancer is present, it cannot be ruled out without a thorough examination by an ENT physician.  If one or more of the following occur, you should see your doctor:

  • a lump in the neck;
  • hoarseness that lasts for more than 2 weeks;
  • an ulcer or swelling in the mouth that does not go away;
  • blood in saliva or phlegm;
  • difficulty swallowing; or
  • constant pain in or around the ear if it is associated with difficulty in swallowing, hoarseness, or a lump in
    the neck;
  • any lesions of the face, head, or neck.

There are a number of different ways in which head and neck cancers may be treated.  Treatment recommendations are based on the size and the location of a cancerous lesion.  Surgical excision is one option. The physician will remove all or as much of the cancerous tumor as possible, in addition to some of the area around the tumor, be it a neck mass, an ear mass, nasal, tongue, laryngeal or tonsil lesion.  This approach may also involve reconstruction of the affected area.  Chemotherapy and/or radiation therapy may be required, as well.

Thyroid Surgery (Endocrine)

Two types of endocrine glands are found in the neck:  the thyroid and the parathyroid glands.   The thyroid gland regulates the body’s metabolism while the parathyroid gland regulates the calcium level in the body so that the nervous and muscular systems will function properly.

The most common diseases of the thyroid are called hyperthyroidism (over-activity of the thyroid gland) and hypothyroidism (under-activity of the thyroid gland). 

There are several causes of hyperthyroidism.  Over-activity of the thyroid may cause the thyroid gland to become enlarged, such as in Grave’s disease.  Inflammation of the thyroid gland (thyroiditis) may also cause an excessive amount of the thyroid hormone to be released from the gland causing a goiter. 

There are two common causes of hypothyroidism.  Sometimes, a previously inflamed thyroid gland can leave the cells of the gland damaged or dead and it can no longer produce a sufficient amount of thyroid hormone.  This type of thyroid gland failure is called Hashimoto’s disease.  Occasionally, hypothyroidism may occur after surgery is done to remove a portion of the thyroid gland because of a nodule or cancer.  If the remaining thyroid cells are incapable of producing enough thyroid hormone for the body, hypothyroidism will result. 

Physicians may order a variety of tests to assist in the diagnosis of a thyroid abnormality.  These tests include:

  • An ultrasonic examination of the neck and thyroid;
  • Blood tests for thyroid function;
  • A radioactive thyroid scan;
  • A fine needle aspiration biopsy;
  • A chest x-ray; and/or
  • A CT or MRI scan.

Thyroid surgery may be necessary to remove all or part of the thyroid gland.  This type of surgery is performed in the hospital under general anesthesia.  Surgery may be needed for the removal of a thyroid nodule (mass), for removal of a malignancy, or for removal of an area that remains questionable, even after a fine needle biopsy.  Patients who have thyroid surgery may be required to take thyroid medication to replace thyroid hormones after surgery.  Some patients need to take a calcium supplement if their blood calcium is low.  This will depend on how much of the thyroid gland remains after surgery and the final diagnosis.

The single major disease of the parathyroid glands is over-activity of one or more of the four small endocrine glands that are located around the thyroid gland.  Too much parathyroid hormone can cause a serious calcium imbalance.  This is called hyperparathyroidism.  Left untreated, hyperparathyroidism may be responsible for osteoporosis, bone fractures, kidney stones, peptic ulcers, pancreatitis, and nervous system problems.  Treatment of hyperparathyroidism requires the removal of one or more of the overactive parathyroid glands.

 

 

American Academy of Otolaryngology

For more information on these and other ENT conditions visit the American Academy of Otolaryngology’s website. http://www.entnet.org/HealthInformation