Head and Neck Surgery

Head and neck surgery encompass the upper aerodigestive tract, ears, skin of face and neck, anterior neck structures (like the thyroid gland and lymph nodes) and salivary glands. Head and neck surgery entail the management (often surgical) of head and neck tumors. Often head and neck cancers involve a team effort with other surgical specialties like neurosurgery, vascular surgery and reconstructive surgery and non-surgical specialties like radiotherapy and chemotherapy involved. Additional therapies may be used like speech therapy, swallow therapy, physiotherapy or psychology.

Head and Neck Surgery
Muscles of the neck and head showing the circulatory system, arteries and veins also the nervous system. Medical illustration

Skin

The most common skin cancers are Basal cell carcinomas (BCC), Squamous cell carcinomas (SCC) and Malignant melanomas. Basal cell carcinoma usually spreads locally with metastatic disease very rare. Squamous cell carcinoma often spreads to regional lymph nodes. Melanomas are the most aggressive, with early systemic metastatic disease. Ultraviolet (UV) radiation is the most common cause. Thus, the cancers usually develop in sun exposed areas. Except melanomas, which can occur in any type of skin, even non-sun exposed skin.

Nasal cavity and paranasal sinuses

Tumors of the nose and sinuses are infrequent. Most are of epithelial origin, although soft tissue and bone tumors do occur. Surgery remains the treatment of choice for tumors, except those that are unresectable. Surgery alone for all benign tumors and early malignant tumors. In the more advanced tumors, surgery is combined with radiotherapy and sometimes chemotherapy. Most surgeries can be done endoscopically, although more advanced tumors may need an external approach.

The Skull Base

The skull base is the floor of the skull and supports the brain. The anterior skull base is the roof of the nose and sinuses, the orbits and nasopharynx. The lateral skull base lies below the middle part of the skull and includes the ear structures. Surgery in these areas can be quite challenging and complex.

Oral cavity and oropharynx

The oral cavity begins at the lips and ends at the anterior tonsillar pillar. The oral cavity (tongue and floor of mouth) is the most predominant location in the head and neck region for primary malignant tumors.

 

The oropharynx begins at the anterior tonsillar pillar and spreads backwards. It includes the soft palate, tonsils, posterior pharyngeal wall and posterior third of the tongue. Tonsil carcinoma is the most common location. Besides smoking and drinking, Human papilloma virus (HPV) infection is a major causative factor.

Hypopharynx and cervical esophagus

The hypopharynx is the lowermost part of the pharynx. It continues inferior into the esophagus and anteriorly it opens into the larynx.

Larynx and trachea

The hypopharynx is the lowermost part of the pharynx. It continues inferior into the esophagus and anteriorly it opens into the larynx.

Cervical lymph nodes

These are lymph nodes found in the neck. There are around 300 lymph nodes in the neck. The lymph nodes are subject to a number of different pathological conditions like infections, inflammation or tumors. Cancers often spread to the lymph nodes, which affect the prognosis and management of the patient.

Thyroid and parathyroid glands

The thyroid is an H-shaped gland in the lower neck, in front of your trachea. The thyroid gland secretes two hormones which regulate your metabolism. The parathyroid glands are four small glands at the back surface of your thyroid gland. They regulate the calcium levels in your blood. Benign and malignant disease in the thyroid is quite common, especially in women. 4-7% of the adult population has a palpable nodularity in the thyroid.

Salivary glands

There are three paired major salivary glands and hundreds of minor salivary glands, that lubricate the upper aerodigestive tract. These glands secrete saliva, that lubricates and protects the mucous membranes.

Neurogenic tumors and paragangliomas

These tumors form a very small percentage of all head and neck tumors. These tumors are usually benign, but a small percentage can undergo malignant transformation. The head and neck region is the most common location for benign peripheral nerve tumors (e.g. Schwannomas). These include acoustic neuromas, facial nerve neuromas and vagal nerve Schwannomas.

Paragangliomas (glomus tumors) can develop in the ear, skull base or neck.

Soft tissue and bony tumors

The most frequently encountered benign tumors are lipomas, hemangiomas, lymphangiomas and neurofibromas. Malignant tumors (sarcomas) can develop from any area of the head and neck, although the parotid, neck, face, forehead and scalp are the most frequently encountered sites.