Head and Neck Cancer Surgery

Surgery is often a first-line treatment for head and neck cancer. Traditional “open” and minimally invasive surgical approaches can be effective in treating head and neck cancers. Our head and neck surgical oncology and reconstruction specialists offer every surgical option available. Our surgeons have specialized training and expertise in head and neck cancer care, are fellowship-trained and focus their practices entirely on head and neck surgery.

To provide the best possible results, our surgeons work within a team-based system, drawing on the expertise of multiple surgeon specialists when needed. Working together, our team offers more effective options when complex surgery is required. Most commonly, this involves complex reconstructive procedures, that help lead to improved functional and cosmetic results for our patients after surgery to remove a tumor.

Minimally Invasive Surgery

Whenever possible, our surgeons offer minimally invasive techniques using smaller incisions and specialized instruments to remove head and neck tumors. Minimally invasive procedures can lead to shorter recovery times, less pain, fewer complications and better outcomes for many patients. Our surgeons are experts in minimally invasive procedures while also having experience with larger, “open” procedures, so that appropriate options may be offered to our patients. 

In many cases, surgery is performed through natural orifices (the mouth or nose) using endoscopes (long, thin tubes with special lighting and lenses). These tools allow the surgeon to visualize tumors and tissues inside the body so that no external incision is needed and no visible scars are created. 

For many of these procedures, surgeons use additional state-of-the-art instruments, as well as microscopes, lasers, robots and other advanced technology to help eliminate cancerous cells while minimizing the disruption of normal surrounding tissues.

Transoral Robotic Surgery (TORS)

TORS is a minimally invasive way to perform surgery for cancer (or benign tumors) of the oropharynx, the larynx and base of the tongue — areas in the back of throat. Robotic technology provides surgeons with a clear, sharp view of what they’re operating on. This allows them to operate with precision and control in areas that are difficult to access with traditional open surgery. In addition to completely removing tumors, TORS can be used to diagnose cancer.

Open surgery in the back of the throat requires a mandibular osteotomy — surgery that involves moving the lower jawbone. Patients also need a tracheostomy (typically temporary) for open surgery, but it’s usually not needed for TORS. A tracheostomy is an incision in the windpipe that provides an air passage for breathing.

What to Expect

To determine if you can have TORS, your surgeon may see you in the clinic but most patients need an endoscopy to pin down the stage and extent of their cancer first. TORS might not be the best choice if you have an extensive or advanced cancer, a very small mouth or airway problems that could make the surgery risky for you. If TORS isn’t the best choice, your surgeon and head and neck cancer team will explain other treatment options that will give you the best possible outcome.

TORS Recovery

Because TORS is minimally invasive, there is less bleeding during surgery, reduced need for blood transfusion, less visible scarring and a lower risk of infection. Other benefits include a shorter hospital stay (typically, a few days), fewer side effects with swallowing, as well as faster and easier recovery and less pain. At home, you will watch for bleeding or signs of infection like a fever, and notify your surgeon immediately if you experience these issues. You’ll need to take it easy for a couple weeks, eat easy-to-swallow foods and take medication for pain. You can return to routine activities in about two weeks.

Expertise

Our head and neck cancer surgeons have received extensive training and are highly skilled in the use of TORS. They use it to treat eligible patients with the following types of head and neck cancers:

• Base of tongue cancer
• Head and neck cancer
• Hypopharyngeal cancer
• Larynx cancer
• Larynx - benign tumors
• Larynx - carcinoid tumors
• Larynx squamous cell carcinoma
• Oropharynx cancer/tumors
• Oropharynx mucoepidermoid carcinoma
• Oropharynx squamous cell carcinoma
• Parapharyngeal space tumors
• Pharynx tumors
• Pyriform sinus cancer
• Retropharyngeal thyroid cancer metastases
• Supraglottic tumors
• Tongue base squamous cell carcinoma
• Tonsil cancer
• Tonsil squamous cell carcinoma
• Vallecular cyst

Transoral Laser Microsurgery (TLM)

Transoral laser microsurgery (TLM) is another minimally invasive surgical technique that our highly trained surgeons use in appropriate situations. The procedure is similar to TORS and aims to preserve surrounding normal tissues as much as possible to help retain a patient’s swallowing and speech functions, while still allowing the surgeon to effectively treat a patient’s tumor. With TLM, a highly specialized carbon dioxide (CO₂) laser beam/fiber is used instead of a scalpel to cut through tissues. This limits damage to normal structures around the tumor, such as important nerves, blood vessels and muscles that are important for a patient’s post-operative function.

Endoscopic Skull Base Surgery

The skull base is a anatomically complex and highly specialized region deep within the cranium and includes vital structures of the head and central nervous system. Our multidisciplinary team of highly-skilled specialists in rhinology/skull base surgery, head and neck cancer surgery and neurosurgery work together to provide the most advanced level of care for patients with tumors of the skull base. Treatment for tumors of the skull base may involve surgery, radiation therapy, chemotherapy or a combination of these. 

For many patients, a more conventional “open” surgical approach may provide more advantages and be required. For others, a minimally invasive or “endoscopic” approach can be offered. Our surgical team is highly trained and specialized and offers both approaches to our patients, ensuring the most effective option is available to every patient. 

In endoscopic skull base surgery, tumors are often accessed through the patient’s nose, sinuses or ears, sometimes allowing for incision-less surgery. Similar to other minimally invasive approaches, these procedures may allow for reduced recovery times, shorter hospital stays and fewer side effects.

Monitoring Prevents Tissue Damage

Head and neck cancer surgeons at Froedtert Hospital use special, precautionary techniques to help prevent injury to vocal cords, facial nerves and other key structures.

• Intraoperative nerve integrity monitoring (NIM), used during thyroid cancer surgery, places a special tube in the throat to continuously monitor the nerves to the vocal cords and avoid injury.
• Continuous facial nerve monitoring is used during certain procedures on tumors of the parotid gland, ear or skull base. Continuous facial nerve monitoring uses electrodes to monitor the nerve that moves the muscles in the face. The surgeon is alerted if there is any stretch or stimulation on that facial nerve, providing another safety measure to avoid facial nerve paralysis as a result of surgery.