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Parathyroid Surgery

The parathyroid glands, as the name suggest, are found next to the thyroid glands. There are fours small(5mm) glands that are very closely attached to the thyroid glands. These glands are responsible for the maintainence of a normal calcium levels in the blood. If any of these glands overgrowth(either hyperplasia or adenoma), it will result in over production of parathyroid hormone, which in turn will result in a high calcium level in the blood. This high calcium blood levels will result in increase excretion of the calcium in the kidneys which are then more prone to kidney stones. The calcium will be mobilised from the bones which can result in fractures. The high calcium can also affect the moods swings(moans) and gastric problems(groans). This is why it commonly remembered as stones, bones, moans and groans.

The main treatment for parathyroid adenoma and hyperplasia is surgical remove of the parathyroids. This is however, can be a difficult and delicate procedure that requires thorough knowledge of the thyroid and parathyroid anatomy. A special detect technique call the sestambi-technitium localising scan is useful to help pre-operative assessment of patients with high calcium and parathyroid hormones.

Head and Neck Cancer Surgery

The organs in the head and neck region are responsible for some of the most crucial functions known to man, such as breathing, speech, swallowing, taste, sight and smell. The sophistication of the functions is paralleled by the complexity of the anatomy in the head and neck region which sets it apart in treatment considerations when affected by disease processes.

Cancer of the head and neck commonly manifests itself as a lump in the neck, and ulcer, pain or discomfort in the throat or a change in the function of speech, breathing or swallowing. The common neck lumps include lymph node and thyroid masses.

Larynx (VoiceBox) Cancer

Laryngeal Cancer (Voice Box) is a common, especially among smokers. Fortunatley, cancer of the voice box usually affects the voice and so patients present early for diagnosis. Sadly, there are patient who still present late due to delay of seeking treatment or diagnosis. Often the patient complains of a change in the voice, throat pain or hoarseness. The patient may have difficulty breathing or swallowing if the larynx cancer is too big. Treatment depends on the site as well as the stage of disease. Early cancer can be treated by Laser Surgery and A/Prof Tan has had several years of experience in this field In advanced cancer of the voice-box, treatment is by chemotherapy and radiation , but may still require surgery if cancer is not well controlled.

If one has to have a voice box removed, A/Prof Tan tries to preserve some of the function and he has performed many partial laryngectomies( hemi-laryngectomies, supraglottic and supracroid). If this is not possible, a total laryngectomy would then be performed. The final goal in treatment of such patients is to enable them to eat and speak, free of cancer.

Take Home: - Early Cancer Diagnosis
- Transoral Laser Surgery
- Partial Layrngeal Surgery
Nasopharynx Cancer

In Singapore, the most common head and neck cancer occurs at the junction of the back of the nose, and the top of the throat (pharynx) called Nasopharyngeal Cancer (NPC). This is a form of nose cancer.

There are approximately 400 new cases of NPC diagnosed each year and it is the sixth most common type of cancer in Singapore. The cause of the disease is focused around three main factors - Epstein-Barr Viral Infection, ethnic & familial trends, and diet.

The majority of the NPC patients are detected at a late stage when patients present with lymph node enlargement in the neck. Other common presentations include blood stained sputum, nose bleeds, nose blockage, ear blockage, tinnitus (ringing sound in the ear) and hearing loss. The diagnosis is made on biopsy of the tumour in the nasopharynx, which shows undifferentiated carcinoma. Treatment of NPC usually involves radiation therapy with possible chemotherapy. We have set protocols of treatment based on our experience over the years in treating this cancer.

Mouth and Throat Cancer

This is a group of cancers which involve the lining of the swallowing and breathing passages. Specific cancer sites include the lips, tongue, buccal mucosa, tonsil, mandible, maxilla, larynx and pharynx. The overwhelming majority are squamous cell carcinoma, which have a different behaviour when compared to Nasopharyngeal Carcinoma (NPC). These cancers are associated with smoking and alcohol consumption and present as ulcers, pain or lumps in the above-mentioned sites, or dysfunction with swallowing or voice. Occasionally, they can present with ear pain due to the same nerve supply of the throat and ear.

However, a large proportion of patients present with lymph node enlargement in the neck suggesting that the cancer spread were detected at a late stage. The treatment modalities include surgery, radiation and chemotherapy. The role of each depends on the tumour site, stage, the individual's overall health, and the chance of function (speech and swallowing) preservation.

Take Home: - Reconstructive Surgery important for restoration of aesthetics and functions of eating, speech, smell and taste.
Upper Neck Lumps

The swelling of the upper part of the neck is a common problem and the common diagnosis in the region included a cervical lymph node, parotid tumour and a parapharyngeal tumour.

In Asia, a mass in this area is in particular the Chinese is commonly associated with a spread from the cancer of the nose(also called Nasopharyngeal Cancer). The lymph nodes are the portal of cancer spread and enlarged usually over a period of months before the patient is aware. There can also be accompanying symptoms in this group of patient such as bleeding from the nose or mouth, hearing loss, ear block, ear ringing or nose discharge. Unfortunately, the upper neck lump represents 60% of all patients who present for the first time who are found to have nose cancer. Thus, having a neck lump can be the first sign of cancer.

Parotid Tumour

A common diagnosis of an upper neck lump is that of a parotid tumour. The parotid gland is one of the large salivary gland( the other called submandibular gland). Fortunately, 80% of the tumours in this parotid gland are benign and the rest being malignant(or cancerous).

 
 
 


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