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Head and Neck Tumors
Head and Neck Cancers
Parotid & Other Salivary Gland Tumors
Parotidectomy
Excision of Submandibular Gland
Zenker's Diverticulum
Head and Neck Cancers
Tumors of the Head and Neck
Risk factors for head and neck cancer include smoking (cigarettes, cigars, pipes), chewing tobacco or snuff, alcohol consumption, poor-fitting dentures that irritate the mouth, and exposure to certain industrial chemicals.
These malignancies can occur anywhere along the upper aerodigestive tract. This can include the oral cavity, nasal cavity and sinuses, salivary glands, oropharynx, hypopharynx, nasopharynx, and larynx.
Evaluation for Head and Neck Cancer
If a closer look at the deeper structures of your throat, larynx and other nearby structures is required, direct laryngoscopy may be performed. During this procedure, a rigid, lighted scope is placed into your throat under general anesthesia. A biopsy, or small sample of your tumor, may be taken and then sent for further studies performed by a pathologist.
Treatment for Head and Neck Cancer
- Surgery - The surgeon may remove the cancer and some of the healthy tissue around it. Lymph nodes in the neck may also be removed (lymph node dissection), if the doctor suspects that the cancer has spread.
- Radiation Therapy - This treatment involves the use of high-energy x-rays to kill cancer cells. A radiation oncologist performs this type of therapy.
- Chemotherapy - also called anticancer drugs. This treatment is used to kill cancer cells throughout the body. Medical oncologists oversee chemotherapy.
Parotid & Other Salivary Gland Tumors
What are salivary glands?
As one might expect, the salivary glands are responsible for secreting saliva into the mouth to moisten the oral cavity and assist in breaking down food. Humans have three pairs of major salivary glands. These consist of the parotid glands, submandibular glands, and sublingual glands. The parotid glands are located anterior to the ear, over the angle of the jaw and extending into the upper neck. The submandibular glands are smaller and are located under the jaw. The sublingual glands are the smallest major salivary glands and are located anterior to the submandibular glands, also under the jaw. In addition to the major salivary glands, hundreds of minor salivary glands, each about the size of a grain of sand, line the membranes of the inside of the mouth.
What are salivary gland tumors?
Tumors can arise from the various cells in the salivary glands when the body’s normal regulating mechanisms do not function the way they are supposed to. Salivary gland tumors can be either benign (non-cancerous) or malignant (cancerous). Tobacco use is a risk factor for the development of malignant salivary gland tumors. As a general rule, the likelihood of a salivary gland tumor being malignant is inversely proportional to the size of the gland. Tumors of the parotid glands, the largest salivary glands, have only a 20% likelihood of malignancy, whereas tumors of the minor salivary glands have an 80% likelihood of being malignant. The most common type of benign salivary gland tumor is a benign mixed tumor, or pleomorphic adenoma. The next most common benign tumor is a Warthin’s tumor, which is found only in the parotid gland, and which can sometimes occur bilaterally. The most common types of malignant tumors of the salivary glands are mucoepidermoid carcinoma, adenoid cystic carcinoma, adenocarcinoma, carcinoma ex pleomorphic adenoma, and acinic cell carcinoma.
How are salivary gland tumors diagnosed?
Most salivary gland tumors are noticed by the patient as a lump in the face or neck. There are rarely any other symptoms. Pain is uncommon. Weakness of the muscles of the face on the side of the tumor is a worrisome finding. Once a salivary gland tumor has been detected, further diagnostic testing, such as a CT or MRI scan, may be recommended. A fine needle aspiration (FNA) biopsy of the tumor may also be recommended to try to determine the type of tumor. It is important to realize that needle biopsies are not 100% accurate. Results of these biopsies should be thought of as a guide, but not an absolute indication as to whether the tumor is benign or malignant.
How are salivary gland tumors treated?
Surgical excision is the treatment of choice for most salivary gland tumors. Even tumors felt to be benign on needle biopsy should generally be removed, since the biopsy may be inaccurate and the tumor will typically continue to grow, leading to increasing cosmetic and functional problems, and potentially more difficult surgery in the future. Exceptions to this recommendation include situations in which a tumor is felt to be benign and the physical condition of the patient makes him or her a poor candidate for surgery. Surgery to remove the parotid gland is called a parotidectomy. Surgeries to remove the submandibular gland or sublingual gland are referred to as excision of submandibular gland, and excision of sublingual gland, respectively. If the tumor is malignant, the physician may recommend additional treatment, including dissection of lymph nodes in the neck beneath the gland (neck dissection), or radiation therapy.
By Cary Moorhead, MD
Parotidectomy
What is a parotidectomy?
Surgery to remove the parotid gland is called a parotidectomy. This surgery is performed through an S-shaped incision starting in the crease in front of the ear, extending below the earlobe and sweeping forward onto the upper neck. A parotidectomy involves locating the facial nerve (the nerve that moves the muscles of expression in the face) and dissecting the parotid gland off of this nerve. The facial nerve runs through the middle of the gland. Approximately 75% of the gland is superficial to the nerve (the superficial lobe), with the remaining 25% lying deep to the nerve (the deep lobe). Most tumors of the parotid gland reside in the superficial portion of the gland, although some tumors may reside in the deep lobe or in both. When only the superficial lobe of the gland is removed, this is referred to as a superficial parotidectomy. When both the superficial and deep lobes are removed, this is referred to as a total parotidectomy. Parotid surgery is performed under general anesthesia and may take two to three hours to complete. It is usually well tolerated, not painful, and most patients resume normal activities within a few days.
What are the risks of a parotidectomy?
Patients who undergo parotidectomy will typically experience permanent numbness in the area around the earlobe, and will have a small depression in the area where the parotid gland was located. The most important risk of parotidectomy is the possibility of injury to the facial nerve, resulting in weakness in some, or all, of the muscles on that side of the face. This injury, if it occurs, is usually transient, although permanent injury to the nerve is also possible. Transient injury to the facial nerve may take weeks to months to recover from. The likelihood of nerve weakness after surgery is significantly higher following a total parotidectomy than it is after a superficial parotidectomy. The risk of facial nerve weakness is also significantly higher with malignant tumors, since these may be attached to the nerves. Other risks of surgery include the development of gustatory sweating, or Frey’s syndrome, a condition in which stimulation of the salivary glands by eating leads to sweating of the skin over the parotid area, and salivary fistula, in which saliva from residual parotid tissue leaks out through the incision.
By Cary Moorhead, MD
Excision of Submandibular Gland
Information Coming Soon!
Zenker's Diverticulum
A Zenker’s diverticulum, more formally known as a hypopharyngeal diverticulum, is a pouch that can form at the junction of the hypopharynx (lower part of the throat) and the esophagus, an area known as Killian’s Triangle. This pouch typically causes problems by trapping food as it is being swallowed, leading to choking and aspiration.
What causes a Zenker's diverticulum?
A Zenker’s diverticulum typically arises due to tightness of the cricopharyngeus muscle. This muscle makes up the upper esophageal sphincter, and is located just below the level of the voice box. Normally, it relaxes during swallowing to allow food to pass into the esophagus. When this muscle fails to relax, the pressure of swallowing pushes the food against the posterior wall of the hypopharynx, causing it to bulge slightly. The combination of obstruction, pressure and bulging, repeated over thousands of swallows, eventually leads to a permanent bulge or pouch -- a Zenker’s diverticulum. The diverticulum continues to enlarge as more and more food is pressed into it.
What are the symptoms of Zenker's diverticulum?
The classic symptoms of a Zenker’s diverticulum consist of difficulty swallowing, a feeling a lump or fullness in the throat, and subsequent regurgitation of undigested trapped food minutes to hours after eating. This unexpected regurgitation of food can lead to aspiration (food particles entering the windpipe and lungs) and, in some cases, pneumonia.
How is a Zenker's diverticulum diagnosed?
A Zenker’s diverticulum is usually diagnosed radiographically with a study called a barium swallow. This study uses radioopaque liquid, barium, which is swallowed, revealing the contour of the hypopharynx and esophagus. The Zenker’s diverticulum is readily visible on the lateral view of a barium swallow. The indentation of the tight cricopharyngeus muscle may also be noticeable.
What are the risk factors of developing a Zenker's diverticulum?
The risk of developing a Zenker’s diverticulum increases as a person ages. People with a history of neurological diseases, such as stroke, are particularly vulnerable to developing a Zenker’s diverticulum.
How is a Zenker's diverticulum treated?
If a Zenker’s diverticulum is causing symptoms, surgical treatment may be recommended. Surgery generally consists of severing the tight cricopharyngeus muscle, and eliminating the pouch. Severing the muscle is critical to the success of this surgery. With a very small diverticulum, simply dividing the muscle can occasionally allow the pouch to decompress, creating a normal esophageal contour. With larger diverticula, muscle division must be combined with a procedure to eliminate the pouch. This can be performed through either an external or endoscopic approach. With an external approach, an incision is made in the neck allowing the surgeon to expose the esophagus. The cricopharyngeus muscle is identified and severed. The diverticulum pouch is identified and excised. With an endoscopic approach, no external incision is made. The esophagus and diverticulum are visualized through a specialized tube called a diverticuloscope placed through the mouth. The wall between these two structures is divided using an endoscopic stapler, which simultaneously severs the cricopharyngeus muscle and opens the diverticulum directly into the esophagus. Endoscopic diverticulectomy is now a relatively quick procedure that can be performed as an outpatient or with an overnight hospital stay.
By Cary Moorhead, MD