Head and Neck Surgery

Parotidectomy

The parotid glands are the most prominent salivary glands just below the ears. They are responsible for making the saliva that enters the mouth through a duct near the back teeth.

A parotidectomy removes these glands and is usually performed due to parotid gland tumours. These tumours are typically benign.

Ranula and Sublingual gland excision

A ranula is a pseudocystic (a well-encapsulated collection of fluid) lesion or a soft, submucosal swelling found on the floor of the mouth. The pseudocyst contains extra saliva that originates from the salivary gland. This fluid collection can be the result of a sublingual duct obstruction or an injury to the submandibular glands.

Surgical excision of the ranula and the sublingual gland is generally the treatment of choice.

Laryngeal microphonosurgery for benign vocal cord lesions

Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. These lesions usually result from phonotrauma, when the normal vocal behaviours are used in excess leading to a vocal fold injury.

Some abnormal or excessive vocal behaviours include:

• Excessive loudness or coughing
• Excess tension while speaking
• Singing after many years of performing

The most common benign vocal cord lesions are:

• Nodules
• Polyps
• Papilloma
• Polypoid degeneration
• Cysts

Regardless of the type of benign vocal fold lesions, they can cause hoarseness by disrupting the ability of the vocal cords to close together and vibrate.

Other common symptoms associated with benign vocal fold lesions include:

• A change in voice quality
• Vocal fatigue
• Unreliable voice
• A low pitched, gravelly voice
• Voice breaks
• Airy or breathy voice
• Inability to sing in a high, soft voice
• The extra force needed for a loud voice

Laryngeal microphonosurgery refers to surgery of the vocal cords using an endoscopic laser inside the larynx to remove the benign vocal fold lesions.

Surgery for VCP (Vocal Cord Paralysis)

Vocal cord paralysis is when the nerve impulses to the voice box (larynx) are disrupted, affecting how the vocal cords work. This condition affects a person’s ability to control the muscles that open and close the vocal cords, usually resulting from nerve damage.

This condition can be the result of various conditions, diseases, injuries or infections, including:

• Autoimmune diseases
• Cancer, such as lung or thyroid cancer
• Connective tissue disorders
• Infections, such as Lyme disease
• Injury or trauma to the neck, head or chest
• Neurological conditions, such as multiple sclerosis or Parkinson’s disease
• Tumours, including malignant or benign tumours

Common symptoms of vocal cord paralysis are:

• Changes in the voice may make your voice sound hoarse, scratchy, weak or ‘breathy’.
• Difficulty swallowing
• Trouble breathing

Laser Transoral Microsurgery

Transoral laser microsurgery (TLM) is a minimally invasive surgery that removes small to medium tumours through the mouth. It is selectively used for larger tumours.

TLM surgery can also be done to treat and manage laryngeal cancer or other head and neck malignancies.

Excision Thyroglossal Duct Cyst

A thyroglossal duct cyst occurs when your thyroid gland leaves behind extra cells while being formed during your development in the womb. These excess cells become cysts. A thyroglossal duct cyst is seen as congenital, meaning that they are present from birth.

The cysts can be small enough not to cause any symptoms or issues in some cases. However, the larger cysts can prevent you from breathing or swallowing properly. In this case, the cysts may need to be removed via an excision procedure.

A sizable thyroglossal duct cyst will present itself as a lump in the middle of the front of your neck between the Adam’s apple and your chin. The lump will move when you swallow or stick your tongue out.

Some other common signs include:

• Speaking with a hoarse voice
• Having trouble breathing or swallowing
• An opening in your neck near the cyst where mucus drains out
• Feeling tender near the area of the cyst
• Redness of the skin around the area of the cyst

Neck Dissection

Neck dissection is typically performed to remove lymph nodes and surrounding tissue for cancer treatment.

Lymph nodes are small glands scattered throughout the entire body. They are responsible for filtering and processing lymph fluid from other organs. Immune cells in the lymph nodes help fight infections. However, when cancer cells spread from another part of the body, they can get caught in a lymph node, where they will continue to grow. When there is cancer in a lymph node, it is known as metastasis. Surgery is usually performed to remove the metastases.

The extent of the tissue that needs to be removed is dependent on the stage of cancer. The main goal of neck dissection is to ensure that all the lymph nodes in a predefined area are removed. Some of the lymph nodes removed may not have cancer in them.

Incision and Drainage Neck Abscess

Neck abscesses are a collection of pus located in either a superficial layer of the neck or deep in the neck.

Superficial neck abscesses are typically the result of an infection in a lymph node. This is known as lymphadenitis. The primary treatment for these abscesses is antibiotics, but the abscess may need to be drained if the infection is not resolved.

The drainage procedure of a superficial neck abscess is quite simple. First, an incision will be made to drain the pus, and a drain will be inserted through the skin to prevent fluid from collecting again. This procedure is generally done under general anaesthesia.

Deep neck abscesses typically require a surgical cut in the neck, too (transcervical). However, they can also be drained via the mouth (orally). The most crucial factor for deep neck abscess procedures is to ensure that the airway is not obstructed, which is why they are usually performed in a hospital setting.

Excision oropharyngeal cancers and head & neck skin cancers

Oropharyngeal cancer is when malignant cells form in the tissues of the oropharynx.

The oropharynx is made up of:

• The back part of the tongue
• The soft palate
• The side and back walls of the throat
• The tonsils

The oropharynx is responsible for safely removing air from the nose and mouth to the larynx. It also moves food from the mouth to the oesophagus.

Excision or surgical procedures are done as part of the treatment for oropharyngeal cancer, including:

• Tumour resection removes the whole tumour and part of the normal-appearing tissue around the tumour.
• Neck dissection
• Laryngectomy, which is a full or partial removal of the larynx
• Tracheostomy is when a temporary or permanent opening is made in the neck used for breathing.

Surgical excisions can also be performed as a skin cancer treatment for the head and neck. The procedure can remove malignant moles, lesions or tumours from the skin and a healthy margin around the affected area.

Surgical excision can also be helpful for melanoma or non-melanoma skin cancers.

Panendoscopy (laryngoscopy, oesophagoscopy, bronchoscopy)

A panendoscopy is a procedure that uses an endoscope to examine the upper part of the airway and digestive system. This includes the larynx, pharynx, upper trachea and oesophagus.

It is performed to evaluate the upper aero-digestive tract system, to look for or remove any abnormalities, including cancer, gastro-oesophageal reflux disease or other airway issues.

Surgery for Pharyngeal Pouch/Zenker’s Diverticulum

A pharyngeal pouch or Zenker’s Diverticulum is a pouch that forms at the beginning of the digestive tract, above the cricopharyngeal muscle. The cricopharyngeal muscle (CP) is where your oesophagus and pharynx come together. This pouch usually develops when the CP muscle does not work correctly, such as not opening or relaxing quickly.

A pharyngeal diverticulum will put pressure on the area above the digestive tract, making it difficult to swallow. As a result, you will have difficulty swallowing food or liquids, or materials will get stuck in the pouch. This will cause you to regurgitate your food or drinks.

Some other symptoms of a pharyngeal diverticulum include:

• Weight loss
• Bad breath due to food being stuck in the pouch dz
• A persistent cough, especially at night
• Regurgitation of undigested food
• Hoarse voice or a change in voice
• Gurgling noises

Total Laryngectomy

Total laryngectomy is the surgical procedure where the entire larynx is removed, and the airway is interrupted. The trachea is then brought up through the skin at the front of the neck as a stoma (hole) that the individual can breathe through. This is known as a tracheostomy.

This procedure is typically performed to treat throat cancer or severe trauma or injury.

Glossectomy

A glossectomy is a procedure performed to remove part of or all of the tongue. It can be done to treat cancer of the tongue, oral cavity or throat.

There are different types of glossectomy; they include:

• Partial glossectomy - part of the tongue is removed.
• Hemiglossectomy - one side of the tongue is removed.
• Total glossectomy - the whole tongue is removed, requiring a laryngectomy and reconstructive surgery.

Segmental Mandibulectomy

The mandible is the most prominent bone in the human skull. It forms the lower jawline, assists in mastication and holds the lower teeth in place.

Surgery to remove this part of the jaw is known as a mandibulectomy, and it is typically done to treat oral cavity cancers.

A segmental mandibulectomy is when the entire jaw bone is removed and reconstructed using bone from another part of the body. Skin grafts and muscle flaps can also be used.