Throat and Neck

Thyroid and Glandular

Thyroid and Neck Ultrasound

The thyroid is an organ in the endocrine system that must be monitored if it becomes swollen. A swollen or dysfunctional thyroid may reveal a lump within the tissue that generally cannot be determined upon examination as benign or malignant.

Performed with in-office ultrasound equipment, the procedure requires a soft gel to be spread across the area of the neck to be observed, which will help the sound waves travel between the machine and the body. The actual imaging itself is completely painless, but if the area to be imaged was tender beforehand some discomfort may ensue.

Ultrasound-Guided Fine Needle Biopsy of Thyroid Nodules and Neck Masses

Thyroid nodules are abnormal growths on the thyroid gland that appear as lumps in the throat. The cause of a thyroid nodule is not known, but they occur most often in older adults and are usually not cancerous. However, thyroid nodules require medical attention to help prevent any complications.

A neck mass is a common condition that involves swelling that changes the shape of the neck. Neck masses do not usually cause any symptoms and often disappear on their own.

They may be caused by:

• Enlarged lymph node caused by infection
• Inflamed or infected cyst
• Trauma
• Inflammation of salivary glands
• Tumor

Neck masses caused by infection can be painful and may require antibiotic treatment. Those that last more than a few weeks should undergo diagnostic testing.

Fine needle aspiration biopsy is used to sample an abnormality within the neck or thyroid without the need for anesthesia. A 22g rather than an 11g needle is used. The procedure is useful for sampling very small masses and can distinguish between cysts and solid masses. The needle is guided by ultrasound to reach only the mass and damage no surrounding tissue.

Small Incision Thyroidectomy with Laryngeal Nerve Monitoring

During a thyroidectomy, the entire thyroid gland and surrounding lymph nodes are removed. This is the most common procedure when thyroid cancer is present to completely remove the disease.

Since the entire thyroid is removed, patients will need to take thyroid hormone replacement drugs, usually for the rest of their lives. The lack of a thyroid will often bring about signs of hypothyroidism, or an underactive thyroid. Symptoms of hypothyroidism may include fatigue, exhaustion, depression, and difficulty concentrating.

Thyroid surgeries are performed through a small incision in the middle of the neck. By using an endoscope, tiny instruments and a video camera, the area is magnified for a surgeon and the operation is less invasive than traditional surgery. The procedure usually takes about two hours and is done under general anesthesia. An overnight hospital stay is required, but most patients are able to resume normal activities the day after surgery. Strenuous activities should be avoided for at least ten days after surgery. Thyroid surgeries are considered safe procedures with few complications. Some people may experience hoarseness or a sore throat because of the breathing tube used during surgery.

During thyroid surgery, the surgeon operates very closely to the laryngeal nerves. Damage to the laryngeal nerves can cause difficulties in speaking and swallowing. Laryngeal monitoring reduces the occurrence of damage by warning the surgeon with lights and/or sounds when the laryngeal nerve is being stimulated. This offers peace of mind to both patient and surgeon, ensuring a successful surgery and lowering the risk of post-operative complications.

Radio-Guided Parathyroidectomy

The parathyroid glands are four small glands in the neck that are part of the endocrine system. They produce parathyroid hormone, or PTH, which maintains calcium and phosphorus levels in the blood. The primary disease associated with the parathyroids is overproduction of PTH, known as hyperparathyroidism.

Surgical removal of one or more parathyroid glands is called a parathyroidectomy. In most cases of hyperparathyroidism, only one gland has to be removed and a procedure called minimally-invasive radio-guided parathyroid, or MIRP, surgery can be performed. MIRP surgery only involves a local anesthetic, requires a much smaller incision and has a very high success rate. The operation usually takes less than 30 minutes and patients may return home within one to two hours. Patients will be able to resume normal activities after just one day. By using rapid PTH testing during the procedure, the surgeon will be able to determine immediately when all of the abnormal parathyroid tissue has been removed. This helps make the surgery more precise and helps shorten the length of the surgery.

Swallowing and Esophagus

Digital Stroboscopy

Digital stroboscopy is an advanced procedure performed to analyze the motion of the vocal cord vibrations in order to identify any potential abnormalities that may be causing hoarseness, sore throat or other symptoms. These movements are invisible to the naked eye, so careful examination can provide insight into the cause of symptoms. This procedure may also be used to compare the appearance and movement of the vocal cords before and after treatment for any detected problems.

The procedure takes about an hour to perform on an outpatient basis, and involves inserting an endoscope with a tiny camera attached to the end through the nose and into the throat, where it is lead to the vocal cords. The stroboscope technology used will capture slow-motion images of the vocal cords while the patient speaks to provide clear, informative photos of the rapidly moving structures, which can be viewed in real-time by the doctor and patient.

While most patients do not experience any pain during this procedure, you may experience a gagging sensation or the urge to swallow. A numbing spray may be applied prior to examination to minimize any potential discomfort and allow your doctor to achieve clear, uninterrupted analysis of the vocal cord movement.

After treatment, a confirmed diagnosis will be made and your doctor will develop a customized treatment plan for your individual condition. Patients can go home immediately after this procedure with no need for recovery or downtime.

Flexible Fiberoptic Laryngoscopy

Flexible fiberoptic laryngoscopy is a diagnostic examination performed to view the throat and its surrounding structures. It is performed using an endoscope attached to a fiberoptic cable, which enables the doctor to view a greater portion of the throat than possible through other diagnostic examinations. A tip-chip features a camera on the end of the laryngoscope, rather than lower down, which provides a better view of the larynx at a higher resolution.

During a flexible fiberoptic laryngoscopy, the endoscope is inserted into the patient's nose and moved into the throat. The patient stays awake, giving the doctor a more accurate view of the vocal cords. After the examination, patients can immediately return to normal activities.

Transnasal Esophagoscopy

Transnasal esophagoscopy, or TNE, is a minimally invasive diagnostic procedure used to evaluate the esophagus in patients suffering from reflux, a condition that causes a chronic cough, throat clearing and a feeling that something is stuck in the throat as a result of abnormalities within the upper esophageal sphincter. This advanced procedure allows your doctor to evaluate the cause of your condition.

During the TNE, the nose is first numbed with a local anesthetic before the endoscope is inserted in through the nose and down to the throat. Your doctor can examine the throat and voice box in real-time, including detecting any changes when swallowing. The endoscope will then be advanced into the esophagus and stomach, if necessary, for further examination.

The entire procedure takes just five to ten minutes to perform. Patients will be able to drive themselves home after this exam and can return to work and other normal activities as soon as they feel comfortable, which is usually right away.

Flexible Endoscopic Evaluation of Swallowing

Flexible endoscopic evaluation of swallowing, or FEES, is a test performed to diagnose swallowing difficulties. FEES is performed with a thin, lighted tube known as an endoscope. The endoscope is placed into the throat. Then, food coloring is placed onto a variety of foods, and fed to the patient; the food coloring makes it easier for the doctor to see how the food is traveling down the throat. After the test, your doctor will discuss the results with you.

Outpatient Endoscopic Treatment of Zenker's Diverticulum

Zenker's Diverticulum is a disorder characterized by the formation of pouches on the esophagus, most typically in older people. The pouches vary in size, but can cause swallowing problems, irritation, regurgitation and bad breath due to food trapped within the pouches. Traditional surgical treatment for Zenker's Diverticulum requires an incision in the neck to access the esophagus, resulting in a hospital stay and an inability to eat solid foods until the healing is complete. Now, however, minimally invasive endoscopic procedures make treatment of Zenker's Diverticulum much easier. Performed on an outpatient basis, no incision is necessary and patients may resume eating food the very next day.

Cancer Screening

Head and Neck Cancer

Head and neck cancers encompass several different diseases that can affect the mouth, nose, throat and other surrounding areas. Most cancers of the head and neck begin in the lining of moist, mucosal surfaces such as the mouth, nose and throat. The cells in the lining are known as squamous cells, and may therefore be affected by squamous cell carcinomas. The different types of cancer associated with the head and neck include:

• Oral cavity
• Salivary glands
• Nasal cavity
• Pharynx
• Larynx
• Lymph nodes

Cancer can spread to other areas of the body and lead to serious complications. Prompt,thorough treatment is essential in restoring the health and overall well-being of patients with head and neck cancer.

Fortunately, many people with head and neck cancers experience symptoms right away that lead to an early diagnosis. Symptoms of head and neck cancers vary, but may include:

• Lump in the neck
• Hoarseness or other change in the voice
• Growth in the mouth
• Blood in saliva
• Difficulty swallowing
• Earache
• New or changed growths on skin

If a patient is experiencing any of these symptoms, a doctor may perform an endoscopy, blood and urine test, imaging test and biopsy, along with a complete physical examination. In order to confirm a diagnosis of cancer, a tissue sample needs to be examined under a microscope.

Once cancer has been diagnosed, it is important to determine the stage of the disease and whether or not it has spread to other areas of the body. Staging usually involves imaging procedures and can help determine the best treatment approach.

Cancer Treatment

Treatment for cancer depends on the type and location of the tumor, as well as the patient's age and overall health. Treatment often includes surgery to remove the cancer, as well as tissue and some surrounding healthy tissue to ensure thorough eradication of the disease. Surgery may cause swelling and bruising, and may affect the patient's ability to chew, swallow or talk. Chemotherapy is often administered after surgery and uses medication to kill cancer cells over repeated treatment sessions. Similarly, radiation therapy uses high-energy x-rays to destroy cancer cells.

Submandibular Gland Surgery

Surgical removal of the submandibular gland may be necessary to provide relief from tumors or chronic infection. Submandibular gland excision is performed under general anesthesia, and patients usually return home the same day.

An incision is made by the neck, under the jawbone. The gland is then removed, and the incision is closed using sutures. After the submandibular gland procedure, a drainage tube is sometimes placed at the site of the incision; this is usually removed after two days. Sutures are removed a week after surgery.

Parotid Gland Surgery

The parotid gland is one of the three major salivary glands in the body that secretes saliva near the upper teeth and helps aid in digestion, oral lubrication and hygiene, and protection against tooth decay. This gland is susceptible to benign or malignant tumors that appear as a lump in front of or below the ear. Parotid gland tumors have often spread from other areas of the body to enter the gland through the lymphatic system. The parotid gland is also at risk for infection or a blocked saliva gland that interrupts normal functioning.

Treatment of these serious parotid gland conditions may require surgical removal of the gland in order to reduce the risk of complications. Removal of the parotid gland, known as parotidectomy, is performed under general anesthesia and may require a short hospital stay. Depending on the size of the tumor, a partial or total parotidectomy may be performed.

Parotidectomy

During a parotidectomy, an incision is made in front of the ear. It is important to identify the facial nerve during this procedure and carefully work around it in order to reduce a patient's risk of facial paralysis. The tumor and a small margin of surrounding tissue are then removed through the incision. The incision is stitched closed with sutures and usually heals well.

Parotidectomy may take several hours to perform, depending on the type of removal and the size and location of the patient's individual tumor. If the tumor is benign, surgery is usually the only treatment required with only a minimal risk of recurrence. Cancerous tumors will likely need to be treated with radiation therapy after surgery to ensure that all cancerous cells have been removed.