Throat and Neck

The thyroid is an organ in the endocrine system that must be monitored if it becomes swollen. A swollen or dysfunctional thyroid may reveal a lump within the tissue that generally cannot be determined upon examination as benign or malignant.

Performed with in-office ultrasound equipment, the procedure requires a soft gel to be spread across the area of the neck to be observed, which will help the sound waves travel between the machine and the body. The actual imaging itself is completely painless, but if the area to be imaged was tender beforehand some discomfort may ensue.

Ultrasound guided Fine Needle Biopsy of Thyroid Nodules and Neck Masses

Thyroid nodules are abnormal growths on the thyroid gland that appear as lumps in the throat. The cause of a thyroid nodule is not known, but they occur most often in older adults and are usually not cancerous. However, thyroid nodules require medical attention to help prevent any complications.

A neck mass is a common condition that involves swelling that changes the shape of the neck. Neck masses do not usually cause any symptoms and often disappear on their own.

They may be caused by:

  • Enlarged lymph node caused by infection
  • Inflamed or infected cyst
  • Trauma
  • Inflammation of salivary glands
  • Tumor

Neck masses caused by infection can be painful and may require antibiotic treatment. Those that last more than a few weeks should undergo diagnostic testing.

Fine needle aspiration biopsy is used to sample an abnormality within the neck or thyroid without the need for anesthesia. A 22g rather than an 11g needle is used. The procedure is useful for sampling very small masses and can distinguish between cysts and solid masses. The needle is guided by ultrasound to reach only the mass and damage no surrounding tissue.

Small Incision Thyroidectomy with Laryngeal Nerve Monitoring

During a thyroidectomy, the entire thyroid gland and surrounding lymph nodes are removed. This is the most common procedure when thyroid cancer is present to completely remove the disease.

Since the entire thyroid is removed, patients will need to take thyroid hormone replacement drugs, usually for the rest of their lives. The lack of a thyroid will often bring about signs of hypothyroidism, or an underactive thyroid. Symptoms of hypothyroidism may include fatigue, exhaustion, depression, and difficulty concentrating.

Thyroid surgeries are performed through a small incision in the middle of the neck. By using an endoscope, tiny instruments and a video camera, the area is magnified for a surgeon and the operation is less invasive than traditional surgery. The procedure usually takes about two hours and is done under general anesthesia. An overnight hospital stay is required, but most patients are able to resume normal activities the day after surgery. Strenuous activities should be avoided for at least ten days after surgery. Thyroid surgeries are considered safe procedures with few complications. Some people may experience hoarseness or a sore throat because of the breathing tube used during surgery.

During thyroid surgery, the surgeon operates very closely to the laryngeal nerves. Damage to the laryngeal nerves can cause difficulties in speaking and swallowing. Laryngeal monitoring reduces the occurrence of damage by warning the surgeon with lights and/or sounds when the laryngeal nerve is being stimulated. This offers peace of mind to both patient and surgeon, ensuring a successful surgery and lowering the risk of post-operative complications.

Radio-Guided Parathyroidectomy

The parathyroid glands are four small glands in the neck that are part of the endocrine system. They produce parathyroid hormone, or PTH, which maintains calcium and phosphorus levels in the blood. The primary disease associated with the parathyroids is overproduction of PTH, known as hyperparathyroidism.

Surgical removal of one or more parathyroid glands is called a parathyroidectomy. In most cases of hyperparathyroidism, only one gland has to be removed and a procedure called minimally-invasive radio-guided parathyroid, or MIRP, surgery can be performed. MIRP surgery only involves a local anesthetic, requires a much smaller incision and has a very high success rate. The operation usually takes less than 30 minutes and patients may return home within one to two hours. Patients will be able to resume normal activities after just one day. By using rapid PTH testing during the procedure, the surgeon will be able to determine immediately when all of the abnormal parathyroid tissue has been removed. This helps make the surgery more precise and helps shorten the length of the surgery.

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