ENT Surgical Consultants Joliet, New Lenox, Morris

Head and Neck Surgery - Thyroid and Parathyroid

Chicagoland’s premier Head and Neck Surgeons. ENT Surgical Consultants is proud to serve our patients with outstanding, comprehensive, cutting edge, and state-of-the-art diagnostic Head and Neck Care.  Please contact us today for a consultation 815-725-1191.


Thyroid Nodules

The thyroid gland is a butterfly-shaped gland located in the low anterior neck. It produces thyroid hormone, which helps to regulate the body’s metabolism. The functional capacity of the thyroid is measured by blood tests. Excessive production of thyroid hormone (hyperthyroidism) can cause palpitations, tremors, weight loss, and heat intolerance. Conversely, an under-active thyroid gland (hypothyroidism) can result in fatigue, weight gain, and cold intolerance.

A thyroid nodule is a growth in the thyroid gland. Thyroid nodules are extremely common, and may be solitary or multiple (multinodular goiter). It is estimated that approximately 5-10% of the population has a palpable thyroid nodule, and between 30-85% have tiny thyroid nodules that are too small to palpate.

In most people with thyroid nodules, the gland produces a normal level of thyroid hormone (euthyroid state). Statistically, approximately 5-10% of nodules are cancerous. Some patients have findings that increase the risk of malignancy. A history of exposure to ionizing radiation to the neck is such a risk factor, as is a family history of thyroid cancer. Hoarseness, lymph node enlargement, and fixation of the nodule can also increase the risk of malignancy. Fortunately, the vast majority of thyroid cancers are treatable and carry an excellent prognosis.

Most thyroid nodules do not require surgery. The primary indications for thyroidectomy are suspicion of cancer, large size, substernal location (nodules that grow inferiorly into the chest), or symptoms (throat pressure, difficulty swallowing, respiratory distress, or cosmetic disfigurement from a visible goiter). Over-functioning nodules are sometimes best treated by surgery, as well.

The most important tests to evaluate a thyroid nodule are a TSH level (a blood test that evaluates the function of the gland) and a fine needle aspiration (FNA) biopsy to evaluate the nodule for malignancy. Although FNA is highly accurate, it is not 100% accurate in making a diagnosis. FNA is usually performed in our office, but for smaller nodules and others that are difficult to palpate, the biopsy is done by the radiologists under ultrasound guidance. There are some types of thyroid nodules (follicular tumors) where FNA cannot distinguish benign from malignant nodules- these nodules are usually best managed by thyroidectomy.


Thyroid Surgery (Thyroidectomy)

Thyroid operations can be divided into several categories, including a unilateral lobectomy (“one-sided” removal of the thyroid gland), total thyroidectomy (removal of both sides of the thyroid gland), or variations in which all of one side of the gland and part of the other side of the gland are removed.

Hospital Course

Patients who have a unilateral (one-sided) thyroidectomy will usually be able to go home the same day with or without a wrap-like pressure dressing in place around the neck. On the day after your discharge, please remove the pressure wrap around your neck if not already done so using a pair of large scissors, or alternatively the wrap may be “unwound” from the neck after any adhesive tape holding the dressing in place has been removed. Your thyroidectomy surgical incision site just above the breastbone will be covered with steri-strips (tape) which will be removed at your follow up appointment. Click here for Head and Neck Wound Care handout for specific instructions.

Patients having a total or subtotal thyroidectomy (operation on both sides of the gland) often go home as well or spend one night in the hospital in order that their calcium levels be monitored, as low calcium levels are seen only with the more comprehensive removal of thyroid tissue. Numbness and tingling in the fingertips or around the lips may be a sign of a low calcium which can be treated by taking calcium (Tums). Please call your doctor if you suspect symptoms of low calcium. Infrequently, a drain is placed during the surgery that is usually removed 1-2 days after surgery. Unless instructed otherwise by your surgeon, the neck wound may be left open to the air. You may shower and get the incision area wet 24 hours after surgery. At least twenty-four hours after receiving general anesthesia, you may drive when you are no longer taking narcotics for pain and able to turn your neck to look for traffic. Be aware that narcotics taken for pain may cause drowsiness, nausea, and constipation. An over-the-counter stool softener such as Colace or Miralax is recommended as prevention. You should avoid strenuous activity for two weeks and call the office to schedule an appointment for about a week after the surgery date.

Medication

Patients will usually be given a prescription for pain medicine, which is to be used as needed. In some cases, you will be also sent home with either a new or continuing prescription for Synthroid, levothyroxine, or Cytomel (thyroid replacement or suppression medication) and this must be used on a regular daily basis at the dose prescribed by your doctor. Calcium and Vitamin D supplements are sometimes prescribed as well.

Complications

Many patients notice a subtle change in their voice quality for the first few weeks postoperatively. Although trauma to the nerves supplying the vocal cords on one or both sides of the voice box may occur during thyroidectomy, frank hoarseness or trouble swallowing is a very rare complication. If you have any questions regarding the fact that your voice may be excessively hoarse or raspy, or if you are experiencing any type of coughing or choking when you attempt to swallow, please call our office immediately.

For patients undergoing a total or subtotal thyroidectomy, normal calcium levels the first several days while hospitalized do not always predict stable blood calcium levels. Occasionally, patients have significant dips in their blood calcium levels after their discharge from the hospital due to manipulating or “bruising” of the parathyroid glands. The symptoms of low calcium would include tingling around the mouth or in the hands or feet, generalized weakness, or feelings of the heart exhibiting an abnormal rate or irregular beat. If any of these symptoms occur, please call our office immediately.

A potentially serious or life-threatening complication of thyroidectomy, which can occur rather abruptly, is formation of a hematoma from a bleeding blood vessel or other area deep in the neck tissues. If you would at any point feel that there has been an abrupt swelling or outward displacement of the wound area in the lower neck, or if the neck wound suddenly starts exhibiting more tenderness, redness, or bogginess than you would expect, you need to contact our office immediately. If any shortness of breath would begin to develop, you are directed to proceed to the emergency room at the hospital where your surgery was performed as quickly as possible. 


ParathyroidParathyroidectomy

Generally, the body has four parathyroid glands that are normally the size of a grain of rice, two on each side of the neck usually hugging the thyroid gland. The parathyroid glands act like thermostats to keep the calcium level in the blood at the normal level (normal calcium is 8.5-10). Occasionally, one or more of the parathyroid glands become overactive and enlarged causing the blood calcium to be high similar to a bad thermostat. So then the overactive parathyroid gland (defective thermostat) needs to be removed to prevent calcium from being pulled out of the bones (osteoporosis) and spilled into the urine (kidney stones). This is called parathyroidectomy. This requires an experienced surgeon because the parathyroid glands are sometimes not where they are supposed to be (ectopic locations). Sometimes more than one parathyroid gland is overactive (15%) and this requires removing 2 or more parathyroid glands. We draw blood tests for PTH levels during surgery to make sure the surgery is successful. If the overactive parathyroid gland has been correctly removed, then the blood PTH level should drop within 30 minutes during surgery. In this particular video, the patient had a rare condition called parathyroid hyperplasia (3%) where all 4 parathyroid glands are enlarged. In this case, three and a half parathyroid glands were removed. Half a gland is left to prevent the calcium from falling too low.

As shown in the video, a Gamma probe can also be used to confirm if a parathyroid gland is overactive.


Facial Nerve Monitoring - (ear and parotid surgery) laryngeal nerve (thyroid and parathyroid)

Facial nerve injury is a devastating surgical complication. It can produce severe changes in facial appearance, expose the eye to infection and complications that can compromise vision, and cause drooling and changes in vocal quality.

Patients who have had severe facial nerve injury can have lowered self-image and loss of self-confidence and self-esteem. Many have reported boughts of depression. These issues can affect both patients work life and social interactions.

NIM-Response® 2.0
Nerve Integrity Monitoring System

A new level of sensitivity and convenience in nerve monitoring

Monitoring of the facial nerve continuously evaluates the activity in the monitored facial muscles. Both a graphic signal, which can be seen on a screen, and an sound signal, which can be heard throughout the procedure room, are generated.

Skin Cancer Removal

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.


Fine Needle Aspiration Biopsy

Fine needle aspiration is a technique that allows a biopsy of various bumps and lumps. It allows your otolaryngologist to retrieve enough tissue for microscopic analysis and thus make an accurate diagnosis of a number of problems, such as inflammation or even cancer.

Why Is It Important?

A mass or lump sometimes indicates a serious problem, such as a growth or cancer*. While this is not always the case, the presence of a mass may require FNA for diagnosis. Your age, sex and habits, such as smoking and drinking, are also important factors that help diagnosis of a mass. Symptoms of ear pain, increased difficulty swallowing, weight loss or a history of familial thyroid disorder or of previous skin cancer (squamous cell carcinoma) may be important as well.

  • When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers are greatly improved if people seek medical advice as soon as possible. So play it safe. If you have a lump in your head and neck area, see your doctor right away.

What Are Some Areas That Can Be Biopsied In This Fashion?

FNA is generally used for diagnosis in areas such as the neck lymph nodes or for cysts in the neck. The parotid gland (the mumps gland), thyroid gland and other areas inside the mouth or throat can be aspirated as well. Virtually any lump or bump that can be felt (palpated) can be biopsied using the FNA technique.

FNA Is Used To Diagnose Masses In:

  • Enlarged neck lymph nodes
  • Parotid gland
  • Thyroid gland
  • Neck cysts
  • Inside the mouth
  • Any lump that can be felt

How Is It Done?

Your doctor will insert a small needle into the mass. Negative pressure is created in the syringe, and as a result of this pressure difference between the syringe and the mass, cellular material can be drawn into the syringe. The needle is moved in a to-and-fro fashion, obtaining enough material to examine under a microscope and make a diagnosis. The procedure is usually repeated several times to insure adequate sampling of the lump. This procedure is quite accurate and frequently prevents the patient from having an open surgical biopsy, which is more painful and costly.

The procedure generally does not require anesthesia, yet your doctor usually injects a small amount of local anesthetic into the skin. It is slightly more uncomfortable than drawing blood from the arm for laboratory testing. In fact, the needle used for FNA is smaller than that used for drawing blood. Although not painless, any discomfort associated with FNA is usually minimal.

What Are The Complications Of This Procedure?

No medical procedure is without risks. Due to the small size of the needle, the chance of spreading a cancer or finding cancer in the needle path is very small. Other complications are rare; the most common is bleeding. If bleeding occurs at all, it is generally seen as a small bruise. Patients who take aspirin, Advil or blood thinners, such as Coumadin, are more at risk to bleed. However, the risk is minimal. Infection is rarely seen.

Tracheostomy

A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube.

A tracheostomy may be done if you have:

  • A large object blocking the airway
  • An inherited abnormality of the larynx or trachea
  • Breathed in harmful material such as smoke, steam, or other toxic gases
  • Cancer of the neck, which can affect breathing
  • Breathed in harmful material such as smoke or steam
  • Paralysis of the muscles that affect swallowing
  • Severe neck or mouth injuries

If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly, leaving a minimal scar.

Occasionally a stricture, or tightening, of the trachea may develop, which may affect breathing.

If the tracheostomy tube is permanent, the hole remains open and may require surgical closure when no longer needed.

Most patients require 1 to 3 days to adapt to breathing through a tracheostomy tube. It will take some time to learn how to communicate with others. Initially, it may be impossible for the patient to talk or make sounds.

After training and practice, most patients can learn to talk with a tracheostomy tube. Patients or family members learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available.

Normal lifestyles are encouraged and most activities can be resumed. When outside, a loose covering (a scarf or other protection) for the tracheostomy stoma (hole) is recommended. Patients must adhere to other safety precautions regarding exposure to water, aerosols, powder, or food particles as well.


Laryngectomy

Laryngectomy is surgery to remove the larynx (voice box) in your throat. All or part of the larynx may be removed in a laryngectomy.

Total laryngectomy is major surgery that is done in the hospital. Before surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.

In a total laryngectomy, first your surgeon will make an incision (cut) in your neck to open up the area. Important parts of this surgery are:

  • Your surgeon may remove the lymph nodes.
  • Your surgeon may do a tracheoesophageal puncture (TEP). A TEP is a small hole made in your trachea (wind pipe) and esophagus (the tube that moves food from your throat to your stomach). Your surgeon will place a small prosthesis (a man-made part) into this opening. The prosthesis will allow you to speak after your voice box has been removed.
  • Your surgeon will remove your larynx and the tissues around it.
  • Your surgeon will make an opening in your trachea and a hole in front of your neck. Your trachea will be brought up and attached to this hole. The hole is called a stoma. After surgery you will breathe through your stoma. It will never be removed.
  • Your muscles and skin will be closed with stitches or clips. You may have tubes coming from your wound for a while after surgery.
  • There are many less invasive surgeries to remove part of the larynx.
  • These may work for some people. The surgery you have may depend on how much your cancer has spread and what type of cancer you have.
  • The names of some of these less invasive procedures are endoscopic (or transoral resection), vertical partial laryngectomy, horizontal or supraglottic partial laryngectomy, and supracricoid partial laryngectomy.
Part of your pharynx may be removed in a total laryngectomy. Your pharynx is the tube air moves through from your nose. It connects with your larynx. The surgery takes 5 to 9 hours.

Usually laryngectomy is done to treat cancer of the larynx. It is also done to treat:

  • Severe trauma, such as a gunshot wound or other physical injury.
  • Severe damage to the larynx from radiation treatment. This is called radiation necrosis.

You will have many doctor visits and medical tests before you have surgery. Some of these are:

  • A complete physical exam and blood tests
  • A visit with a speech therapist and a swallowing therapist to prepare for changes after surgery
  • Nutritional counseling
  • Stop-smoking counseling, if you are a smoker and have not quit

Always tell your doctor or nurse:

  • If you are or could be pregnant
  • What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription
  • If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day

During the days before your surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • You will be asked not to drink or eat anything after midnight the night before your surgery.
  • Take your drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

You will need to stay in the hospital for several days after surgery.

After the procedure, you will be groggy and will not be able to speak. An oxygen mask will be on your stoma. It’s important to keep your head raised, rest a lot, and move your legs from time to time to improve blood flow. Keeping blood moving reduces your risk of getting a blood clot.

You can use warm compresses to reduce pain around your incision. Your nurse will give you pain medicine.

You will receive nutrition through an IV (a tube that goes into a vein) and tube feedings. Tube feedings are given through a tube that goes through your stoma and into your esophagus (swallowing tube).

You may be allowed to swallow food as soon as 2 to 3 days after surgery. But, it is more common to wait 5 to 7 days after your surgery to start eating through your mouth.

Your trachea drain will be removed in 2 to 3 days. You will be taught how to care for your tracheostomy tube and stoma. You will learn how to safely shower or swim. You must be careful not to let water enter through your stoma.

Speech rehabilitation with a speech therapist will help you relearn how to speak.

You will need to avoid heavy lifting or strenuous activity for about 6 weeks. You may slowly resume your normal, light activities.

Follow up with your doctor as often as your doctor says you need to.

Your wounds will take about 2 to 3 weeks to heal. You can expect full recovery in about a month. Many times, removal of the larynx will take out all the cancer or injured material. People learn how to change their lifestyle and live without their voice box.


Overview - Oral Cancer

Oral cancer includes cancers of the mouth and the back of the throat. Oral cancers develop on the tongue, the tissue lining the mouth and gums, under the tongue, at the base of the tongue, and the area of the throat at the back of the mouth.

Oral cancer accounts for roughly three percent of all cancers diagnosed annually in the United States, or about 49,700 new cases each year.

Oral cancer most often occurs in people over the age of 40 and affects more than twice as many men as women. Most oral cancers are related to tobacco use, alcohol use (or both), or infection by the human papilloma virus (HPV).

Causes

Tobacco and alcohol use. Tobacco use of any kind, including cigarette smoking and chewing tobacco, puts you at risk for developing oral cancers. Heavy alcohol use also increases the risk. Using both tobacco and alcohol increases the risk even further.

HPV. Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to oral cancers.

Age. Risk increases with age. Oral cancers most often occur in people over the age of 40.

Sun Exposure. Cancer of the lip can be caused by sun exposure.

Symptoms

If you have any of these symptoms for more than two weeks, see a dentist or a doctor.

  • A sore, irritation, lump or thick patch in your mouth, lip, or throat
  • A white or red patch in your mouth
  • A feeling that something is caught in your throat
  • Difficulty chewing or swallowing
  • Difficulty moving your jaw or tongue
  • Swelling in your jaw
  • Numbness in your tongue or other areas of your mouth
  • Pain in one ear without hearing loss

Diagnosis

Because oral cancer can spread quickly, early detection is important. An oral cancer examination can detect early signs of cancer. The exam is painless and takes only a few minutes. Many dentists will perform the test during your regular dental check-up.

During the exam, your dentist or dental hygienist will check your face, neck, lips, and entire mouth for possible signs of cancer.

Treatment

When oral cancer is detected early, it is treated with surgery or radiation therapy. Oral cancer that is further along when it is diagnosed may use a combination of treatments.

For example, radiation therapy and chemotherapy are often given at the same time. Another treatment option is targeted therapy, which is a newer type of cancer treatment that uses drugs or other substances to precisely identify and attack cancer cells. The choice of treatment depends on your general health, where in your mouth or throat the cancer began, the size and type of the tumor, and whether the cancer has spread.

You should see an, ear, nose, and throat doctor (otolaryngologist)

Helpful Tips

Oral cancer and its treatment can cause dental problems. It’s important that your mouth is in good health before cancer treatment begins.

See a dentist for a thorough exam one month, if possible, before starting cancer treatment to give your mouth time to heal after any dental work you might need.

Before, during, and after cancer treatment, ask your health care provider for ways to control pain and other symptoms, and to relieve the side effects of therapy.


Overview - Salivary Gland Disorders

Salivary glands are located in the mouth. There are three pairs of large salivary glands. Parotid glands are found in front of and just below each ear. Submandibular glands are below the jaw. Sublingual glands are under the tongue. There are also hundreds of smaller glands. These glands make saliva (spit) and empty it into the mouth through openings called ducts. Saliva makes food moist, which helps chewing and swallowing and the digestion of food. Saliva also keeps the mouth clean and healthy because it contains antibodies that kill germs.

If the salivary glands are damaged or aren’t producing enough saliva it can affect taste, make chewing and swallowing more difficult, and increase the risk for cavities, tooth loss, and infections in the mouth.

Causes

Salivary Gland ObstructionObstruction: Small stones that form in the gland ducts may obstruct the flow of saliva. The gland may swell and become painful and infected. Small constrictions or twists in the duct system of the large salivary glands can also decrease salivary flow.

Infection: When saliva pools behind an obstruction in a duct, the gland can become infected. Infection of the lymph nodes from a sore throat or cold can also cause a secondary infection in the salivary glands.

Tumors: Tumors usually appear as painless enlargements in one of the salivary glands. Malignant (cancerous) tumors often grow quickly, may or may not be painful, and may cause loss of movement in the affected side of the face.

Other Disorders: Diseases such as HIV-AIDS, and autoimmune disorders such as Sjögren's syndrome and rheumatoid arthritis, can make the salivary glands inflamed and painful. Diabetes may also cause enlargement of the salivary glands. Alcoholics may have salivary gland swelling, usually on both sides. Some medications also cause decreased saliva and dry mouth as a side effect.

Symptoms

Problems with salivary glands can cause them to become irritated and swollen. You may have symptoms such as:

  • a bad taste in your mouth
  • difficulty opening your mouth
  • dry mouth
  • pain in your face or mouth
  • swelling of your face or neck or under your tongue

Diagnosis

A doctor uses your medical history, a physical examination, and laboratory tests to make a diagnosis of a salivary disorder.

If your doctor suspects your pain and inflammation are the result of an obstruction in one of the glands, he or she may order X-rays or ultrasound to identify where the obstruction is and what might be causing it.

If a mass is found in the salivary gland, your doctor will suggest a CT scan or an MRI to get a better look at the problem. Your doctor might also use a fine needle aspiration biopsy to explore further. A lip biopsy of minor salivary glands may be needed to identify certain autoimmune diseases, such as Sjögren’s syndrome.

Treatment

Salivary disorders are treated according to what is causing them, using medical or surgical treatments. If the salivary disorder is caused by systemic disease (diseases that involve the whole body) then that problem is treated first. This may require a visit to an ENT specialist. If the problem is due to salivary gland obstruction, your doctor might use a probe and dilate the duct to remove the obstructive stone.

If a tumor has developed within the salivary gland, your doctor may recommend its removal. You may be referred to an otolaryngologist (commonly known as an ear, nose, and throat doctor) who performs surgery. Most tumors in the parotid gland area are benign (noncancerous). If a tumor is cancerous, it will be surgically removed and the area treated with radiation therapy afterwards.

Helpful Tips

Radiation therapy often causes dry mouth, which can increase your risk for cavities and mouth infections. Here are some tips to keep your mouth moist:

  • Drink plenty of fluids throughout the day and take a water bottle with you wherever you go.
  • Keep your mouth clean. Rinse your mouth before and after meals with plain water and brush your teeth after meals.
  • Take small bites, and chew your food well.
  • Suck on lemons or sour candy or chew gum to stimulate saliva.
  • Avoid caffeine, alcohol, and tobacco.
  • Use over the counter saliva substitutes to add moisture to your mouth.
  • Massage swollen salivary gland firmly as often as possible.
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