ENT physicians perform surgery to remove tumors in the head and neck, working closely with medical and radiation oncology experts as part of a patient's cancer treatment team. A few of the conditions we treat are explained below; however, our specialists treat a wide variety of head and neck cancers that are not listed. Please contact our office to discuss your specific case and we are glad to recommend an appropriate specialist.
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For more information or to schedule an appointment with an ear, nose and throat specialist, call our scheduling line: 202-295-0556
The neck contains muscles and nerves which work together to move the head, neck, and shoulders. The neck also contains lymph nodes which help to drain fluid from the head and face.
Neck dissection is a surgical procedure that involves removal of the deep neck lymph nodes and surrounding tissue from the neck for the purpose of cancer treatment. Several types of neck dissection exist, including:
- Selective - Least extensive
- Modified - More extensive
- Radical - Most extensive
Click here to view a guide of exercises following neck dissections.
Cancer Reconstruction: Skin Grafts and Local Flaps
Local and rotational flaps are used to reconstruct small to moderate-sized defects in the skin that are created by trauma, surgery, and and/or cancer. The skin and subcutaneous tissue is lifted from an adjacent donor site and rotated to the area which needs reconstruction. A thin layer of skin (aka “skin graft”) may be taken from another area if there is not adequate tissue in the locally adjacent area to allow closure.
A cervicofacial rotation flap is used to transfer skin and soft tissue from the lower face and neck to defects of the face and cheek closer to the center. The primary goals of cheek reconstruction include the restoration of native function, maximization of aesthetic outcome, and limitation of repair-related morbidity.
Paramedian forehead flaps, nasolabial flaps, and abbe (cross-lip) flaps are all performed in three stages. Flaps can also be transferred from scalp skin, which is some of the least elastic skin on the body.
A skin graft is taken from a donor site area with good color and thickness match to the area that needs reconstruction. Some potential skin graft donor sites include: behind the ear, in front of the ear, on the neck overlying the clavicle, and in the natural groin crease. After the skin is excised from one of these areas, the surgical site is able to be closed with layered sutures in a linear fashion. The sutures are removed one week after surgery.
Major Reconstructive Surgery (Free Tissue Transfer)
A free flap is a tissue graft that contains an arterial and venous blood supply. The tissue graft, along with its artery and vein, is lifted from a donor site (usually the arm, leg, abdomen or back), and then it is transferred to the area which needs reconstruction. The surgeon then reconnects the artery and vein of the tissue graft to the carotid artery and jugular vein in your neck in order to re-establish blood flow within the flap. The operation requires meticulous technique as the surgeon re-connects blood vessels having a diameter of approximately 1/10th inch using sutures that are finer than human hair. These sutures are not usually visible to the naked eye, which require special instruments and techniques. A thin layer of skin (a skin graft) may be taken from your groin or thigh to cover the free flap donor site if the free flap is taken from the arm or the leg. If your arm or leg is the donor site, a secure dressing will be placed to protect the site from constant motion which can potentially disrupt healing.
The free flaps can be harvested from the fibula, radial forearm, or anterolateral thigh. The routine hospital stay after a free flap surgery is 7-10 days.
Melanoma is a disease in which malignant (cancer) cells form in melanocytes (cells that color the skin). Unusual moles, exposure to sunlight, and health history can affect the risk of melanoma. Signs of melanoma include a change in the way a mole or pigmented area looks. Certain factors affect prognosis (chance of recovery) and treatment options. Being white or having a fair complexion increases the risk of melanoma, but anyone can have melanoma, including people with dark skin.
Signs of melanoma include a change in the way a mole or pigmented area looks, specifically a mole that:
- Changes in size, shape, or color
- Has irregular edges or borders
- Is more than one color
- Is asymmetrical (if the mole is divided in half, the 2 halves are different in size or shape)
- Oozes, bleeds, or is ulcerated (a hole forms in the skin when the top layer of cells breaks down and the tissue below shows through)
Certain factors affect prognosis (chance of recovery) and treatment options:
- The thickness of the tumor and where it is in the body.
- How quickly the cancer cells are dividing.
- Whether there was bleeding or ulceration of the tumor.
- How much cancer is in the lymph nodes.
- The number of places cancer has spread to in the body.
- The level of lactate dehydrogenase (LDH) in the blood.
- Whether the cancer has certain mutations (changes) in a gene called BRAF.
- The patient’s age and general health.
Meet our Specialists
- Michael Reilly, MD – Melanoma surgery, Mohs wound closure, reconstructive surgery, microvascular free flaps
- Jonathan Peter Giurintano, MD – Microvascular free flaps, reconstructive surgery
- Timothy Deklotz, MD – Sinonasal tumors, skull base tumors
- Bruce Davidson, MD – Thyroid and parathyroid cancers, HPV + oral cancer, Larynx/throat, gum/gingeva, tonsils
- Eugenia Chu, MD – Mohs wound closures, reconstructive surgery
- Nazaneen Grant, MD – Laryngeal cancer, vocal cord/voicebox tumors
- William Gao, MD – Laryngeal cancer, vocal cord/voicebox tumors
- Suzette Mikula, MD – Basal cell carcinoma
- Hung Jeffrey Kim, MD – Acoustic neuroma, glomus tumors, meningioma
- Michael Hoa, MD – Acoustic neuroma, glomus tumors, meningioma
Frequently Asked Questions about Head and Neck Cancer
What is head and neck cancer?
Head and neck cancer encompasses a wide variety of cancers. These include cancers of the thyroid, salivary glands, voice box, mouth, throat, and various cancers of the neck.
What are the risk factors for head and neck cancer?
Usually when referring to cancers of the mouth and throat the risk factors are higher for tobacco and alcohol use. However, previous radiation exposure can raise the risk of head and neck cancer.
How are head and neck cancers discovered?
In most cases, patients have some symptom for at lease a few months before they go to a physician. This can be throat pain, mouth pain, an ulcer, or pain referred up to the ear. However, often times people will not go to a physician until there is a lymph node enlarged in the neck.
Who makes the diagnosis of head and neck cancers?
Typically, the person best suited to make the diagnosis is an otolaryngologist, head and neck surgeon. An otolaryngologist can evaluate the entire throat and mouth, and preform an endoscopy or biopsies if needed.
Are there different types of head and neck cancer?
For thyroid and salivary cancers, there are a variety of types of cancers that can occur in these tissues. For mouth and throat cancers, the majority of these types of cancers are squamous cell cancers.
What are the treatments options for cancer of the mouth and throat?
For small tumors, either surgery or radiation can be equally effective. However, the side effects of each treatment differ and that drives the decision as to how to treat each particular patient.
Higher stage tumors such as larger tumors in the mouth and throat, or tumors that have spread to lymph nodes in the neck and even occasionally tumors that have spread beyond the head and neck, require more than one modality of treatment. This could be a combination of surgery and radiation or chemotherapy and radiation. Sometimes all three modalities (surgery, radiation, and chemotherapy) maybe used.
When is surgery best and when is radiations best for oral tumors?
Typically, tumors of the oral cavity, the mouth and tongue, are better treated by surgery and tumors further, the deep throat and voice box, are better treated with radiation therapy due to the difficulty getting access to the area.
How are you using CyberKnife radiation to treat throat cancer?
CyberKnife is helpful for radiating tumors of the throat when a patient needs a higher dose of radiation to a particular area. CyberKnife may also be used when a patient has had previous treatments, including radiations, and re-irradiate is needed. CyberKnife allows for this without giving radiation broadly to the neck and throat.
How does the da Vinci Surgical System help with surgery for throat cancer and other cancers of the head and neck?
For small tumors of the throat, getting access to them, use to require significant dissection through the neck which put nerves at risk and disrupted swallowing. The da Vinci robot allows access to the throat to resect small tumors. The tonsils and the tongue base can be accessed allowing the tumors to be resected. The resected tumor is removed through the mouth without any external incisions and removed with negative margins. Similar to a tonsillectomy for a non-cancer problem.
Watch the video below to see Dr. Bruce Davidson answer commonly asked questions about head and neck surgery, including the risk factors of oral cancer and surgical advances.