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Head and Neck Surgery



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Chapter 9 : Head and Neck Surgery



Head and Neck Surgery arrow_upward


  • Head and Neck Surgery is the surgical treatment of the diseases, injuries, or deformations of the head and neck areas.
  • Head and Neck Surgery generally include the following:
    • Removal of Parotid Gland
    • Biopsy of basal cell carcinoma of face
    • Removal of stone from Submandibular Duct

    Removal of Parotid Gland arrow_upward


  • The Parotid gland is the largest salivary glands that produce saliva.
  • Parotid gland is wrapped around the mandibular ramus, and secretes saliva through Stensen ducts into the oral cavity to facilitate mastication, swallowing and to begin the digestion of starches.
  • The parotid gland is divided into two lobes:
    • Lateral lobes
    • Medial lobes
  • Parotidectomy is a major surgical procedure to remove the parotid gland which is one of the two major salivary glands found in the human body.
  • Parotidectomy is done for tumors of the parotid gland and occasionally for recurrent infections of the gland.

  • Purpose

  • The main purpose of Parotidectomy is to remove abnormal growths (neoplasm) that occur in the parotid gland.
  • Parotid gland neoplasm may be benign or malignant.

  • Surgery

  • During surgery, two different areas of the parotid gland are identified: the superficial lobe and the deep lobe.
  • Superficial Parotidectomy removes just the superficial lobe, while total parotidectomy removes both lobes.
  • The surgery is performed under general anesthesia and may take anywhere from 90 minutes to over 3 hours depend on the location of the mass.
  • If the parotid mass is located near the bottom of the parotid gland below the ear, the surgery usually is shorter than if the mass was located near the eye and further away from the ear.

  • Steps to the Surgery

  • After anesthesia, the incision is carried down to just above the parotid gland and the overlying skin carefully dissected away.
  • Once the parotid gland is completely exposed, dissection is now carried deep to the parotid gland to identify the facial nerve and all its branches.
  • Once all the facial nerve branches are exposed and protected, the parotid mass itself is removed.
  • A surgical drain is placed to remove any blood accumulation.
  • Incision is closed.

  • Biopsy of Basal Cell Carcinoma of Face arrow_upward


  • BCCs are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis.
  • Basal cell carcinoma is a slow-growing form of skin cancer.
  • Basal cell skin cancer grows slowly and is usually painless.
  • Skin cancer is divided into two major groups:
    • Nonmelanoma
    • Melanoma
  • Basal Cell Carcinoma (BCC) is a type of nonmelanoma skin cancer.
  • The majority of these cancers occur in the area of skin that is regularly exposed to sunlight or other ultraviolet radiation.

  • Symptoms

  • The cancer may appear as skin bump or growth that is:
    • Pearly or waxy.
    • White or light pink.
    • Flesh-colored or brown.
  • Other symptoms include:
    • A skin sore that bleeds easily.
    • A sore that does not heal.
    • Oozing or crusting spots in a sore.
    • Appearance of a scar like sore without having an injured area.
    • Irregular blood vessels in or around the spot.
    • A sore with a depressed area in the middle.

    Treatment

  • Treatment depends on the size, depth, and location of the skin cancer.
  • Methods used to treat basal cell carcinomas include:
    • Excision
    • Curettage and Desiccation
    • Surgical Excision
    • Cryosurgery
    • Mohs Micrographic Surgery
    • Radiation Therapy

    Excision

  • Cutting out the skin cancer and stitching the skin together.

  • Curettage and Desiccation

  • It consists of scooping out the basal cell carcinoma by using a spoon like instrument called a curette.
  • Curettage is the process of removing tissue by scooping and/or carefully scraping away the basal cell.
  • The desiccation process involves an electric current to reduce bleeding and eliminate remaining cancer cells.

  • Surgical Excision

  • Excision cuts the tumor out and uses stitches to place the skin back together.

  • Cryosurgery

  • Cryosurgery freezes and kills the cancer cells.
  • Liquid nitrogen is applied to the growth to freeze and kill the abnormal cells.

  • Mohs Micrographic Surgery

  • Mohs surgery is the surgery in which skin is cut out and immediately looked at under a microscope to check for cancer.
  • The process is repeated until the skin sample is free of cancer.

  • Radiation Therapy

  • Radiation therapy is a cancer treatment. It uses high doses of radiation to kill cancer cells and stop them from spreading.
  • Radiation treatments are used for skin cancer occurring in areas that are difficult to treat with surgery.

  • Melanoma

  • Melanoma is the most dangerous type of skin cancer. It is the leading cause of death from skin disease.
  • Melanoma is caused by the changes in cells called melanocytes, which produce a skin pigment called melanin.
  • Melanin is responsible for skin and hair color. It can appear on normal skin, or it may begin as a mole or other area that has changed in the appearance.
  • Some moles that are present at the birth may develop into melanomas.
  • There are four major types of melanoma:
    • Superficial spreading melanoma is the most common type. It is usually flat and irregular in shape and color with different shades of black and brown. It is most common in Caucasians.
    • Nodular melanoma usually starts as a raised area that is dark blackish-blue or bluish-red. However, some do not have any color.
    • Lentigo maligna melanoma usually occurs in sun-damaged skin on the face, neck, and arms. The abnormal skin areas are usually large, flat, and tan with areas of brown.
    • Acral lentiginous melanoma is the least common form. It usually occurs on the palms, soles, or under the nails.

    Removal of Stone from Submandibular Duct arrow_upward


  • The submandibular gland is the second most common location for a pleomorphic adenoma.
  • Salivary gland stones most commonly occur in the submandibular gland's duct (Warthin's Duct) because of its more mucoid secretion and uphill flow.
  • There are three pairs of major salivary glands located in and around the mouth and throat:
    • Parotid
    • Submandibular
    • Sublingual glands
  • Salivary gland stones are most commonly occurs in the Submandibular Gland's duct.
  • Salivary gland stones occur when calcium deposits in the duct of the gland, blocking the flow of saliva, causing pain and discomfort associated with eating.

  • Treatment

  • Sialendoscopy is a cutting edge procedure that allows successful stone removal without injury to surrounding structures.
  • Sialendoscopy allows endoscopic transluminal visualization of major salivary glands and offers a mechanism for diagnosing and treating both inflammatory and obstructive pathology related to the ductal system.
  • Benefits of Sialendoscopy:
    • No surgery, No incision, No scar
    • No risk of nerve damage
    • No risk of bleeding
    • Fast recovery time
    • Preservation of normal salivary gland and duct
    • Same day procedure in a safe outpatient setting
    • Early return to normal diet


    Thank You from Kimavi arrow_upward


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