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Thyroid Nodules/Ultrasound Guided Needle Biopsies
Thyroid nodules are common, and the majority do not require surgery.
"Lumps and bumps" in the head and neck can frequently be assessed and the physical exam augmented by the use of ultrasound. Ultrasound is the dominant method for assessing thyroid masses. While the images are somewhat limited in depth and scope (compared to a CT scan...), it does not require radiation and can be repeated over time essentially without risk. In most cases, ultrasound-guided needle biopsies are done in the office. This technique has wide application for the evaluation of tumor infiltration, metastasis, staging and screening of the neck for recurrence post cancer treatment.
When large or needle biopsy-confirmed suspicious masses are identified, partial or total thyroidectomy, as well as neck dissection, can be necessary. This gland sits on top of a major nerve to the voice box and is often adherent to calcium-regulating glands behind the thyroid. Nerve monitoring is helpful in the avoidance of injury to the adjacent nerve. Overnight admission to the hospital is anticipated for thyroidectomy.
Head and Neck Cancer/Flap Reconstruction
The treatment of head and neck cancers may be limited to chemotherapy and radiation or may include surgical excision of the tumor followed by chemo/radiation.
Tumor excision may result in a defect, or “hole,” where the tumor and surrounding tissue were removed. Tissue transplant for the coverage of head and neck cancer defects is now the common method of reconstruction in this patient population. A skin and fat flap from the thigh is the most utilized and least debilitating followed by the fibular free flap in the case of mandibular (jaw) reconstruction. When combined with tumor excision, these are extensive procedures frequently requiring tracheostomy, feeding tubes and an extended/ 7 to 10 day stay in hospital. There is an occasional role for leg muscle (gracilis), back muscle (latissimus) and standard rotational flap methods (pectoralis, temporalis) depending upon the need.
Facial Fractures/Mandible Fractures from Trauma
Motor vehicle accident and aggravated assault are the common mechanisms for cheek, nasal, mandible and orbital fractures. Plate and screw repair in the hospital is the rule. Elements of airway obstruction, eye/brain and peripheral injury can lead to an extended hospital stay. Isolated facial injury in the absence of these complicating elements generally requires only an overnight stay in the hospital.