Common Surgical Procedures - Oral cavity and throat

This section discusses oral cancers, tonsils and adenoids, and surgery of the thyroid. For a discussion of cosmetic surgery of the face area, see “Plastic and Cosmetic Surgery” later in this chapter.

Oral Cancers

There are many potential problems of the mouth, or oral cavity, besides an occasional toothache. Surgical treatment frequently is needed to correct a disorder or to prevent a life-threatening situation from developing. Cancers of the lips, tongue, hard and soft palate, and other areas of the mouth, for example, affect about 25,000 people in the United States each year. Elsewhere in the world, the incidence varies considerably according to sex and location; the rate in Hong Kong for men is three times the figure for women, and the incidence of oral cancer for women in Hong Kong is nearly 10 times as high as that of women in Japan. Environmental factors such as tobacco and contact with chemical and physical agents have been suggested as causes, although one form of oral cancer, known as Burkitt's lymphoma , is believed to be transmitted by a mosquito-borne virus.

Cancer of the Lip

Oral cancers tend to occur after the age of 45. Some types of oral cancer, particularly when the lips are affected, are found most frequently in persons exposed to a great deal of sunlight. Farmers, sailors, and other outdoor workers develop such tumors around the age of 60, with the lesion appearing on the lower lip. Like other cancers, cancer of the lip may begin as a tiny growth, but, if untreated, can spread through neighboring tissues and eventually destroy part of the chin. Treatment may include both radiation therapy and surgical excision of the growth; if surgery is performed when the tumor is small, the scar is likewise small. Obviously, the larger the tumor is allowed to grow, the more difficult the treatment.

Cancer of the Cheek

Similarly, cancers that develop on the inner surface of the cheek usually can be excised and the wound closed with simple surgery if treatment is started early. If the cancer is allowed to grow before treatment, the surgery becomes more complicated with removal of tissues extending to the outer skin layers and repair of the wound with skin grafts. Radiation therapy also may be used to augment the surgical repair.

Cancer of the Mouth

Cancer of the floor of the mouth may be second only to lip cancer in rate of occurrence of oral cavity tumors; together they may account for half of the oral cavity cancers in the United States. A tumor of the floor of the mouth may involve the under surface of the tongue, the lower jawbone, and other tissues of the area. A small lesion detected early can be controlled in most cases by excision of the growth and radiation therapy.

Cancer of the Tongue

The tongue may be the site of cancerous growths beginning in the 30s of the patient's life, particularly if the individual is a heavy user of tobacco and alcohol and has been neglectful of proper oral hygiene, such as brushing the teeth regularly. If the growth is at the tip of the tongue rather than underneath or along the sides, the operation is easier and there is less chance that the normal function of the tongue will be impaired by removing the growth and surrounding tissue cells. Radiation therapy for cancer of the tongue sometimes involves the implantation of needles containing radium into the tongue. The procedure is done while the patient is under a general anesthetic. Tumors at the base of the tongue, as well as some growths on the floor of the mouth, sometimes are approached through an incision in the neck.

Other Surgery

Apart from cancers, surgery of the oral cavity may be needed to treat genetic defects, such as cleft lip and cleft palate, damage to tissues from injuries, and noncancerous tumors of the soft tissues, such as cysts.

Tonsils and Adenoids

Tonsils and adenoids are glands of lymphoid tissue lying along the walls near the top of the throat. The tonsils are located on the sides of the pharynx, or throat, near the base of the tongue. Unless an adult's tonsils are inflamed, they may not be easily visible to a physician or other person looking into the throat, but when inflamed and swollen they can be seen without difficulty. The adenoids are located higher in the pharynx and cannot be seen by looking into the back of the mouth without special instruments, because the palate, or roof of the mouth, blocks the view.

Tonsillitis

The function of the tonsils and adenoids apparently is that of trapping infectious organisms that enter the body through the nose and mouth. But sometimes the glands do such a good job of collecting infections that they lose their effectiveness, becoming enlarged and inflamed, a condition known as tonsillitis . The patient develops fever and sore throat and the breathing passages become obstructed. The infections can spread through the nearby Eustachian tubes to the ears, causing otitis media (inflammation of the middle ear), resulting in deafness. Disease organisms also can spread from the tonsils and adenoids to the kidneys, joints, heart, eyes, and other body areas. Many youngsters survive occasional bouts of tonsillitis, and the infections can be treated with antibiotics and medications to relieve pain and fever symptoms. But many surgeons recommend that the tonsils and adenoids be removed if tonsillitis occurs repeatedly.

Tonsillectomy

A tonsillectomy (removal of the tonsils) is not a complicated operation, but it usually is performed under a general anesthetic if the patient is a child. A local anesthetic may be used for an adult. The adenoids usually are removed at the same time; they consist of the same type of lymphoid tissue in the same general area, and adenoids develop similar problems from the same kinds of infectious agents. An overnight stay in the hospital may be required or it may be possible for the patient to have the tonsils and adenoids removed in the morning and be released from the hospital in the evening of the same day, after a few hours of postoperative rest under medical observation.

Preoperative and Postoperative Care

The patient may receive antibiotic medications two or three days prior to surgery and is instructed to avoid eating foods or drinking fluids for at least 12 hours before the operation. If the patient has a cold or other viral infection, the surgery may be delayed or postponed. Some surgeons also prefer to avoid tonsillectomy operations during the hay-fever season. If there is any evidence of bleeding after the patient is released, such as spitting blood, he is returned to the hospital and the surgeon is notified; the bleeding usually can be controlled without difficulty. The patient also returns for checkups a couple of weeks after the operation and again about six months later.

Adenoidectomy

In some cases, a surgeon may recommend an adenoidectomy (removal of the adenoids) without a tonsillectomy. This is particularly true when the patient suffers from recurrent ear infections and hearing loss. An adenoidectomy is a relatively simple operation performed under a local anesthetic when the patient is an adult or older teenager; a general anesthetic is preferred for younger patients.

The surgeon can reach the adenoid mass through the open mouth of the patient. The tissue grows on a palate ledge near the point where the nasal passage enters the back of the mouth cavity. Using a special instrument, the surgeon cuts away the adenoid tissue within a few minutes. A medicated pack is inserted into the postnasal area to help control bleeding and the patient is moved to a recovery room. The only aftereffects in most cases are a soreness in the postnasal area for a few days and, occasionally, a temporary voice change that is marked by a nasal tone while the wound heals.

Thyroid Surgery

The thyroid gland lies along the trachea, or windpipe, at a point just below the Adam's apple. Secretions of the thyroid gland are vital for metabolic activities of the body, and the gland's functions are closely orchestrated with those of other endocrine glands of the body. When the thyroid is less active than normal, mental and physical functions are slow and the patient gains weight. When the gland is overly active, body functions operate at an abnormally fast pace, with symptoms of weight loss, irritability, heart palpitations, and bulging eyes. Occasionally, lumps develop on the thyroid, requiring medical or surgical treatment. A lump on the thyroid gland may be a nodular, or nontoxic, goiter. Or it could be a tumor. A nodular goiter poses several threats: it can make the thyroid gland become overactive, it can press on the windpipe and cause hoarseness, or it can develop into a cancer. Some growths of the thyroid gland can be treated effectively with medications, radiation, or a combination such as radioactive iodine. However, when conservative forms of therapy no longer appear to control the condition, or when it is suspected that a thyroid growth may be a malignant cancer, surgical removal of the affected area is advised promptly.

Surgical Procedure

The operation itself is fairly simple. An incision is made through the skin folds of the neck, neck muscles beneath the skin are separated, and the affected portion of the gland is cut away. The neck and throat area may be sore and painful for a few days after the operation; within a few weeks the patient can resume normal activities. A thin scar remains at the line of incision, but it is usually partly concealed by skin folds of the neck.