Thyroid, Parathyroid and Head & Neck Surgery

WHAT IS A HEAD AND NECK/ENDOCRINE SURGEON?

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Head and neck/endocrine surgeons are otolaryngologists (ENT physicians) who have special expertise in treating tumors of the head and neck and disorders of the endocrine glands of the neck.  They either have formal fellowship (post residency) training in this area or have significant personal experience with these disorders. Such conditions include both benign and malignant tumors of the head and neck (excluding tumors of the eye and brain), salivary gland tumors, and disorders of the thyroid and parathyroid glands.

HEAD AND NECK CANCER

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Cancers of the head and neck include malignancies of the oral cavity, pharynx, larynx (voice box), and neck.  Historically such malignancies were often associated with tobacco and alcohol usage and those substances remain important etiologic factors.  In recent years there has been a marked increase in the incidence of head and neck cancer (particularly malignancies of the tonsils and tongue base) caused by infection with the human papilloma virus (HPV).

SYMPTOMS OF H&N CANCER

Hoarseness

Difficulty swallowing

Painful swallowing

Throat pain

Weight loss

Persistent ear pain without hearing loss

Persistent neck mass (often painless)

Oral bleeding Stridor (noisy breathing)

Patients exhibiting any of these symptoms should be evaluated by one of the physicians at ENT and Allergy Associates as soon as possible.

TREATMENT OF H&N CANCER

There are numerous options to treat H&N cancer. The most common treatments include surgery, radiation therapy, and chemotherapy. The optimal treatment must be individualized for each cancer and each patient, depending upon the type of cancer, the site of the cancer, the stage (extent) of the cancer, and the underlying health status of the patient. Click here to read more...

These complex malignancies often require the expertise of numerous physicians and para health professionals (speech language pathologists, dieticians, physical therapists, occupational therapists) in different specialties working in a collaborative, team-oriented approach. Such specialists may include head and neck surgeons, plastic and reconstructive surgeons, skull base surgeons, neurosurgeons, radiation oncologists, and medical oncologists.

HEAD & NECK/ ENDOCRINE PROCEDURES

Thyroidectomy

Para thyroidectomy

Parotidectomy

Excision of submandibular gland for infection or tumor

Excision of benign and malignant laryngeal (voice box) tumors

Excision and reconstruction of tumors of the mouth, larynx, pharynx, and neck

Excisional of congenital masses of the head and neck

Excision and reconstruction of skin cancers of the head and neck

Some of these tumors involve more than one site in the head and neck, and it is not unusual for some tumors to require a team approach, including head and neck surgeons, plastic and reconstructive surgeons, rhinologists and skull base surgeons, and neurosurgeons.

HPV THROAT CANCER

HPV is a sexually transmitted virus that can cause cervical cancer in women. In recent years there has been an epidemic of HPV induced cancers of the oropharynx, particularly cancers in the tonsils and base of tongue.

CAN I BE SCREENED FOR HPV INFECTION?

Currently, there is no routine screening tool available to identify patients at risk for HPV cancer. Although vaccination against HPV infection is available and may confer protective immunity when administered to preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. Those with significant risk factors should have a thorough head and neck examination, including flexible fiber optic laryngoscopy, by one of the physicians at ENT and Allergy Associates.

THYROID NODULES

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The thyroid gland is a butterfly-shaped gland located in the low anterior neck. It produces thyroid hormone, which helps to regulate the body’s metabolism. The functional capacity of the thyroid is measured by blood tests. Excessive production of thyroid hormone (hyperthyroidism) can cause palpitations, tremors, weight loss, and heat intolerance. Conversely, an under-active thyroid gland (hypothyroidism) can result in fatigue, weight gain, and cold intolerance. 

FINE NEEEDLE ASPIRATION BIOPSY OF THYROID NODULES

One of the major advances in the treatment of thyroid nodules over the past 25 years has been the adoption of fine needle aspiration (FNA) as a screening tool to help determine when thyroidectomy is required. Thyroid nodules are extremely common but only approximately 10% of all nodules are cancerous. While advanced malignancies are usually readily apparent, most benign and malignant nodules cannot be differentiated on the basis of examination alone.

PAROTIDECTOMY

The parotid gland is the largest of the salivary glands, all of which produce saliva to help lubricate the oral cavity during meals. It is located just anterior to the ear, with extensions behind the ear and inferiorly into the upper neck. The most common indication for parotidectomy is tumors in the gland; the operation is rarely performed for severe, recurrent infections within the gland. Click here to read more...  Fortunately, most parotid tumors (85-90%) are benign. The malignancies vary widely in their aggressiveness and prognosis; many low grade parotid cancers are highly curable with surgery. The most common parotid tumor is a pleomorphic adenoma, also called a benign mixed tumor. Pleomorphic adenomas have been known to degenerate into cancers if they are neglected for many years, hence the standard treatment for most parotid tumors is surgery.

HYPERPARATHYROIDISM

The parathyroid glands are tiny glands in the neck that help to regulate the level of serum calcium. When the blood calcium level drops, the parathyroid glands release parathyroid hormone (PTH), which helps to raise the level of serum calcium. Once the serum calcium level returns to normal, PTH production usually stops. In hyperparathyroidism one or more parathyroid glands become independent and continue to produce PTH. As a result, the serum calcium climbs. The resulting hypercalcemia can result in metabolic complications such as kidney stones, osteoporosis, brittle bones that can easily fracture, and abdominal pain. Click here to read more...The most common symptom of hyperparathyroidism is probably fatigue, however, since there are so many other potential causes for fatigue, you can never be certain if it is parathyroid-related until after surgery. Some patients with hyperparathyroidism are completely asymptomatic.

IN-OFFICE ULTRASOUND

Office-based ultrasound is fast becoming an essential tool in the management of neck disease. It enables the clinician to more fully answer questions pertaining to head and neck anatomy, progression of disease, pathology and preoperative mapping. It provides the patient one-stop service with more accurate, higher yielding guided biopsies, all without the need to expose the patient to radiation. 

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