Head and Neck Cancer Surgeon

One of My Interesting Head and Neck Surgeries

I love my job. Being an otorhinolaryngologist-head and neck surgeon means you’ll never know what surgical challenge may come your way. One day, it may be doing a revision of a cleft lip surgery. On another day, it may be removing a fishbone stuck in a patient’s throat. Or some days, it may be a challenging head and neck cancer surgery such as this case.

She was referred to me by another head and neck surgeon for co-management. Her story began 1 year before the consult when there was a rapidly enlarging mass under her left ear. 2 months before her consult, she noted weakness in her smile and her ability to close her eyes. A needle biopsy was done which revealed a high-grade mucoepidermoid carcinoma of the parotid gland (a cancer of the salivary gland) and she was advised surgery

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

his is the picture of her CT scan showing invasion of the structures deep to the jaw. There was also spread to the lymph nodes near the great vessels of the left neck. She was then scheduled for surgery: wide excision of parotid gland tumor, facial nerve sacrifice, and modified radical neck dissection on the left. In layman’s terms, that means removing the tumor, with margins of 1.5 cm of normal tissue, identifying the trunk of the nerve which moves the face (remember that she already had facial nerve paralysis before the surgery so that means the nerve was already invaded by the tumor) and removal of all the lymph nodes surrounding the great vessels of the neck.

The next picture was taken after the tumor was removed. The reason why this is one of my memorable surgeries is, despite the size of the tumor, because of the details of the anatomy.

In the picture below, I placed the picture taken intra operatively after removing the tumor, side by side with the diagram from the anatomy book. This is the dissection of the area near the jaw. In this picture, you will appreciate how, despite the big tumor, we were able to preserve, and dissect with care the great vessels supplying the head and the brain (the carotid and the jugular), the hypoglossal nerve (Cranial nerve 12-the nerve which controls tongue movement), the spinal accessory nerve (Cranial nerve 11, which controls shoulder movement), the facial artery, as well as other structures like the digastric muscle, and even the ansa cervicalis. I’m sure this sounds like Greek to most non medical readers. But my greater point here is that choosing a competent surgeon is important especially for head and neck surgeries because of all the vital structures that control our voice, swallowing, shoulder and tongue movements and supply blood to our brain.

 

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Thyroid Problems

The butterfly shaped organ located in the middle of your neck beneath the Adam’s apple (thyroid cartilage).

It has 2 lobes wrapped around the thyroid cartilage (windpipe) which are joined together in the middle by the isthmus.

This endocrine gland uses iodine in producing chemicals Thyroxine, triiodothyronine called thyroid hormones, which are important in regulating metabolism, growth and development. These hormones are especially important in pregnancy and in chidhood because it affects brain development.

Thyroid problems may be classified into 2.

  1. Those that affect thyroid hormone production

  2. Problems that affect thyroid size

Hyperthyroidism is a disorder where the thyroid gland produces more thyroid hormones than usual. The most usual cause is Grave’s disease, an auto-immune disorder where the body produces the antibody thyroid-stimulating immunoglobulins (TSI) which misdirect the thyroid to make too much thyroid hormones T3 and T4.

Symptoms are:

-palpitations

– rapid heart rate

– increased sweating or always feeling warm

– easy fatigability

-shortness of breath

-weight loss

-menstrual complaints

– diarrhea

Hypothyroidism, on the other hand, is a disorder where the thyroid gland produces less thyroid hormones than the normal values. The usual causes are

  1. Hashimotos thyroiditis, another auto immune disorder where the body produces antibodies which attack the thyroid gland, resulting in less production of thyroid hormones

  2. Previous treatment of hyperthyroidism, such are radio-active iodine

  3. Changes in the thyroid gland structure

The following are symptoms of hyperthyroidism:

  1. Lack of motivation or

always feeling tired

  1. Feeling cold

  2. Depressed feelings

  3. Hair loss

  4. Weight gain

  5. Bowel problems

  6. Hoarseness

  7. Heart problems

Goiter is the term used to describe any enlargement of the thyroid gland. It may be caused by

  • Infection

  • Inflammation

  • Iodine de