Head & Neck Surgery Introduction

The Head & Neck Surgical Oncology unit was started in 2006 at this hospital by Dr. Rajendra B. Metgudmath who has been trained in Tata Memorial Hospital, Mumbai under the eminent surgeons. The unit handles all kinds of cancers arising in Head & Neck region. Conducts regular Awareness programmee regarding Head & Neck Cancers & Bad effects of Tobacco & Alcohol & also conducts Screening camps. The unit is supported by well experienced senior consultants from related surgical branches such as Department of Plastic surgery, Cardiovascular & Neurosurgery. The unit also receives support from the state of art operation theaters, intensive care units, comprehensive diagnostic facilities, blood bank and well experienced senior consultants of the Department of Anesthesiology, Prosthodontics & Physiotherapy.

Surgeries Offered:

  • Mandibulectomies.
  • Glossicetomies
  • Maxillectomies
  • Thyroidectomies
  • Laryngectomies
  • Parotidectomies
  • Parathyroidectomies
  • Submandibular gland excision
  • Neck dissections.
  • Microlaryngeal surgeries
  •  Excision of Carotid Body Tumour
  • Other Para pharyngeal mass excision.
  • Tracheal resections for sub-glottic stenosis.
  • Per oral wide excisions
  • Direct laryngoscopies & biopsy
  • Pedicle flap reconstructions.
  • Micro vascular flap reconstruction ( Plastic surgeon)

Head and Neck cancer
Head and Neck cancers are the malignant growths originating in the lip, oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, thyroid, nasal cavity, paranasal sinuses, salivary glands, skull base and cervical lymph nodes of the neck. Head and neck cancers are most commonly squamous cell carcinomas.

Incidence:

Head and neck cancer poses a serious health risk. Head and neck cancer is the fifth most common malignancy worldwide. The worldwide incidence exceeds half a million cases annually. Oral cancer has the highest incidence of the head and neck cancers and it is more common in men than in women. The incidence of oral cancer rates is higher among people from a South Asian (Indian sub-continent). Approximately 90% of Head & Neck cancers are squamous cell carcinomas.

What causes cancer?

Consumption of Tobacco-quid, gutka, Smoking cigarettes- cigars, pipes and beedis, Marijuana, drinking alcohol, occupational exposures - nickel refining, textile fibers and wood working, Dietary factors- lowest consumption of fruits and vegetables, Viral aetiology, Chronic irritation (such as that from rough teeth, dentures, or fillings).

Symptoms:

The following are the list of few of the symptoms which a patient suffering from head and neck cancer may complain. Lump in the neck, swallowing difficulty, feeling of something is sticking in the throat, long standing ulcer, chewing problems, breathing difficulty, hoarseness of voice, bleeding from the nose, persistent cough, earache, loss of weight. Pain and paraesthesia are late symptoms.
Diagnosis:

A through clinical examination is of at most important in diagnosing the cancer. Histopathological examination should also be performed. Computed Tomography scan (CT scan) and Magnetic Resonance Imaging (MRI) have been universally accepted as vital tools for clinical staging. Newer imaging modalities such as Positron Emission Tomography (PET scan) and the identification of sentinel nodes by means of lymphoscintigraphy, show promising results.

Treatment:

For an each specific cancer the selection of appropriate treatment depends on a many factors that include tumor site, extent, histology, intent of treatment, quality of life to be offered post treatment.The relative morbidity of various treatment options, nutritional status, patient performance, co-existing health problems, social and logistic factors, therapy anticipated for potential recurrences are the other major issues. Co-morbidities associated with consumption of tobacco and alcohol can affect over all treatment outcome. When different treating modalities are available, the modality that gives maximum chance of cure should be used.
Surgical resection and radiation therapy are the mainstays of treatment for most head and neck cancers and remain the standard of care in most cases. For small primary cancers without regional metastases (stage I or II), wide surgical excision alone or curative radiation therapy alone is used. For more extensive primary tumors or for those with regional metastases (stage III or IV), planned combinations of pre- or postoperative radiation with concurrent chemotherapy and complete surgical excision are generally used. The micro vascular flaps have revolutionized the reconstruction of head & neck surgical defects whose characteristics are similar to those of the native organ. Following the definitive treatment, rehabilitation may be necessary to improve cosmosis, swallowing, speech and movement of joints.
For patients with metastatic disease, in whom cure is no longer an option; the goal of treatment is prolonging life with various cytotoxic regimens that may achieve measurable reductions in tumor and providing palliation through control of symptoms.

What is the prognosis?

The five year relative survival varies from 20-90% depending upon the sub site of origin and the clinical extent of disease. It is over 80% for early stage and localized disease. Over 40% for whose disease has spread to the neck and below 20% for those who have distant metastatic disease. Over 60% of head and neck cancer patients present with advanced disease.It has been estimated that between 10 and 30% of patients with primary oral cancer develop second primary upper aerodigestive tract tumors.

Summary:

Head and neck cancer remains a disfiguring disease associated with a high mortality rate. Emphasis should be given on the early detection of the cancerous lesion. Results are good in earlier stages of the disease. Screening is a means of detecting disease early in asymptomatic individuals, with the goal of decreasing morbidity and mortality.

How do I prevent or control cancer?

Regular health cheak-up and maintaining good oral hygiene. Avoiding smoking, chewing tobacco and its various products. Avoiding consumption of alcohol. Emphasis on consumption of fruits and vegetables. Consumption of food which are rich in vvitamins such as dietary carotenoids and retinoids.
"Human life is most precious. Cancer is a curse to humanity. Control it before it is too late".

PAPERS PRESENTED AND AWARDS CONFERRED:

  1. Awarded the Dr. K. C. Prasad Gold medal for best consultant paper presentation for paper on "Versatility of Pectoralis Major Myocutaneous Flap in Oncosurgery" at 29th AOI Karnataka State E.N.T Conference held during 16th to 18th September 2011 at J. N. Medical College, Belgaum.
  2. Awarded the Dr. A. Mahadevaiah Gold medal for best consultant paper presentation for paper on "The Diagnostic Uses of Serum Adenosine Deaminase, 5'nucleotidase & Retinol in Oral & Laryngeal Cancers – A Cross Sectional Study" at 29th AOI Karnataka State E.N.T Conference held during 16th to 18th September 2011 at J. N. Medical College, Belgaum.
  3. Presented a paper on "Prosthetic Rehabilitation in Head & Neck Oncosurgery" in the Award Category for consultant, at 29th AOI Karnataka State E.N.T Conference held during 16th to 18th September 2011 at J. N. Medical College, Belgaum.
  4. Presented Paper titled "Misadventures of Laser – A Case report" in the Award Category for consultant, at 6th AOI South Zone & 28th AOI Karnataka State E.N.T Conference 22nd to 24th October 2010 at Mysore.
  5. Presented Poster titled "Tobacco V/S Oncosurgeon – Treachorous Head & Neck Malignancy" in the Award Category for consultant, at 6th AOI South Zone & 28th AOI Karnataka State E.N.T Conference22nd to 24th October 2010 at Mysore.
  6. resented poster Titled "Evaluation of Vitamin A and serum enzymes in oral and laryngeal cancers" in the Award Category, at 10th FHNO – IFHNOS 2010 Conference13th to 15th October 2010 at The Taj Residency, Bengaluru.
  7. Presented poster Titled "Single Staged Reconstruction of Head & Neck post surgical defects using pedicle flap" in the Award Category, at 10th FHNO – IFHNOS 2010 Conference13th to 15th October 2010 at The Taj Residency, Bengaluru.
  8. Presented a paper titled "Neurogenic Tumours of Parapharyngeal Space" in the Award Category for consultant, at 26th AOI Karnataka State Conference on 29th, 30th, & 31st October 2008 at Davangere.
  9. Presented a paper titled "A comparative study of minor salivary gland tumors of oral cavity and oropahrynx versus Nose & Para Nasal sinuses – A 10 year Review" at 6th National Conference of Foundation of Head & Neck Oncology (of India) on 27th to 29th October 2006 at Udaipur.
  10. Presented a paper title "Vascular anomalies of neck" at South Zone & 24th AOI Karnataka State Annual Conference on 13th to 15th October 2006 at J. N. Medical College, Belgaum.
  11. Presented a paper titled "Scenario of Head & Neck malignancy – My Experience" in the Award Category for consultant, at South Zone & 24th AOI Karnataka State Annual Conference on 13th to 15th October 2006 at J. N. Medical College, Belgaum.
  12. Presented a paper titled "Tumors of minor salivary glands-Retrospective study" at 57th All India National ENT Conference on 6th to 9th January 2005 at Hyderabad.
  13. Presented a paper titled "Nasolabial cyst- a case report" at 54th All India National ENT Conference on 10th to 13th January 2002 at Bangalore.
  14. Presented a paper titled: Polyostotic eosinophilic granuloma – a case report in the Award Category for post graduates, at 20th Annual State E.N.T. Conference on 12th & 13th May 2001 at Chitradurga.