The Nerve! And Why It’s Important to Choose a Really Good Head and Neck Surgeon
“Doctor, when I undergo a thyroidectomy, will I not be able to talk for a month? My neighbor said so”
“Doctor, when have my mass from the parotid gland removed, will half of my face not be able to move?
Above are just some questions I get from patients before undergoing a procedure. And I understand where the fear is coming from.
The head and neck is the a very delicate area when it comes to surgery. After all, this is where 4 of the 5 senses are located (sense of sight, hearing, smell and taste). Furthermore. it contains the nerves which control the movement of the face as well as the movement of the vocal cords which is crucial to our communication and swallowing, among other things.
Have you tried looking for a needle in a haystack? Well, unless, as a surgeon, you’ve done hundreds of surgeries, as well as applied the things you read in the surgical books, finding these important nerves is like finding a haystack under a big tumor.
See this picture on the left. This is a thyroidectomy procedure (we were removing a goiter from a patient). occupying the upper half of the picture is the thyroid gland being held by Babcock clamps . See the white thing (in the center of the picture) being pointed to with the forceps and the green arrow? That is the recurrent laryngeal nerve inserting at the cricothyroid area to control the vocal cords. The yellow round thing at the end of the blue arrow is the parathyroid gland, which controls calcium production.
With this picture, you see how small these important structures are in relation to the surrounding structures. The nerve in this area typically has a diameter of 1 to 2 MILLIMETERS. And this is a small thyroid gland. it was around 4 x 3 CENTIMETERS. We’ve done surgeries with tumors much bigger (as much as 4 times this size) than this, and still preserved the nerve and the parathyroid, AND still had minimal blood loss. It’s all about knowledge, skills and attention to details.
Below is another picture of anatomy details. This is a parotid cancer (I’ll be writing another blog about this case). On the right side is the diagram of the anatomy of the right side of the neck and jaw. See how delicate neck surgery is with all the great vessels supplying the head as well as nerves controlling tongue movement, shoulder movement, diaphragm movement. Any trauma to these structures will be of detriment to the patient, and may affect him or her for the rest of her life.
This last case is something I will write about in another blog. This is an ear cancer. This is a picture after we removed the tumor from the external ear, drilled down the mastoid bone and traced the facial nerve from bone up to the 5 branches. See the beautiful detail to anatomy, compared to the diagram on the right?
I hope these pictures show how important it is for you to choose a knowledgeable and competent surgeon especially when it comes to head and neck procedures.