Surgery for Head & Neck Cancer

Doctors at Perlmutter Cancer Center prefer using minimally invasive surgeries, when appropriate, to help preserve the ability to swallow and offer a better quality of life. Open surgical procedures may be needed to treat larger portions of the pharynx or larynx.

Our doctors may remove tumors from the larynx, the vocal cords or voice box, or the pharynx, the passageway from the nose to the esophagus in the back of the throat. They may use endoscopic transoral surgery for pharyngeal or laryngeal tumors and transoral laser microsurgery for early laryngeal cancer. Surgeons may use robot-assisted surgery for cancers in the part of throat directly behind the mouth.

Endoscopic Transoral Resection

Endoscopic transoral resection involves removing a laryngeal or pharyngeal tumor through an endoscope, a thin, lighted tube with a lens at the end that’s attached to a video camera or an operating microscope to better show the anatomy of the area. It may be the only treatment needed for early laryngeal cancer.

During this procedure, the doctor inserts the endoscope through the mouth and into the pharynx or the larynx. He or she places a small surgical instrument into the scope or may use a laser beam to remove the tumor.

Doctors can also use endoscopic transoral resection to manage larger, more advanced laryngeal or pharyngeal tumors. If portions of the larynx need to be removed, they can often be reconstructed to restore your ability to speak.

Transoral Laser Microsurgery

To spare as much of the vocal cords as possible, doctors may use laser microsurgery to manage small laryngeal cancers and precancerous laryngeal tissue, or dysplasia. For this procedure, doctors use an endoscope through which they place a laser to excise or destroy tissue.

Transoral Robotic-Assisted Surgery

Perlmutter Cancer Center doctors may use robotic-assisted surgery to remove some tumors of the oropharynx, the portion of the throat at the back of the mouth. Robotic-assisted surgery gives surgeons an excellent view of the back of the throat and enhances their ability to perform delicate procedures.

Surgeons at NYU Langone’s Robotic Surgery Center use a system that consists of tiny instruments, such as a surgical knife or laser, mounted on robotic arms. A separate arm contains a camera that creates magnified, high-definition, three-dimensional images on a computer monitor, which guide the surgeon during the procedure.

The surgical tools and camera are inserted through the mouth to the back of the throat. The surgeon controls these instruments and the camera from a console in the operating room.

Microvascular reconstructive surgery is often used to restore appearance and maintain function of the oral cavity. Operating on a large tumor may involve removing and reconstructing part of the jaw, the roof of the mouth, or the tongue. Sometimes teeth are removed and replaced with dental implants by surgeons who specialize in the mouth, face, and jaw. Depending on the location of the cancer, portions of the lip may also be removed and reconstructed.

Our doctors determine the best approach for removing a sinonasal cancer based on its location and size and the surrounding structures. Doctors may use endoscopic resection, a procedure performed through the nose, nasal cavity, and sinuses that doesn’t require making any visible incisions; open surgery, which requires incisions on the face; or a combination of both.

Endoscopic Surgery

Sinonasal cancers affect the nasal cavity and the sinuses. These areas are surrounded by vital structures, including the base of the skull and brain; the optic nerves, which run from the eyes to the brain; and the carotid artery, a major vessel that supplies blood to the brain, neck, and face.

The endoscope—a thin, lighted tube with a lens at the tip that’s attached to a video camera—enables the doctor to see the tumor and the surrounding structures. To perform endoscopic sinonasal surgery, the doctor inserts the endoscope through the nose and into the nasal cavity or sinuses to view the cancer. He or she removes the cancer—along with a small amount of adjacent healthy tissue to help ensure that all cancer cells are gone—using surgical tools inserted through the scope.

Using this approach, the doctor can often remove the entire tumor through the nose. Head and neck surgeons often work with neurosurgeons when a tumor is close to the brain or important nerves.

Endoscopic surgery enables doctors to repair any openings created when removing a tumor at the base of the skull. These holes can leak cerebrospinal fluid, the liquid that cushions the brain and spinal cord. The doctor can plug the holes with your own tissue or a substance similar to natural tissue.

Craniotomy

Doctors may perform open surgery, which requires making an incision in the face and through the skull, to remove large sinonasal cancers that have grown into the skin or skull bones. During the procedure, which is called a craniotomy, NYU Langone neurosurgeons monitor the brain and important nerves to preserve their function. General anesthesia is required.

The most common salivary gland cancer is parotid gland cancer. It is most often removed surgically. Doctors typically can preserve the facial nerve, which runs through the parotid gland and helps control facial expressions. Your surgeon makes an incision in front of your ear and down your neck, and removes the tumor, surrounding tissue, and sometimes nearby lymph nodes.

When other salivary glands are involved, surgery is the most common treatment. The approach depends on the type and location of the tumor. Many people with this type of cancer may also have radiation therapy to destroy any remaining cancer cells.

For most types of thyroid cancer, surgery is recommended. This may involve removing part or all of the thyroid. If there is evidence that the cancer has spread to nearby lymph nodes, the surgeon removes them as well. This procedure is usually performed along a skin crease in the front of the neck. Care must be taken to avoid damage to the nerves leading to the larynx. Our surgeons are experts in this technique.

During surgery, doctors may remove lymph nodes in the neck that contain cancer or are suspicious for cancer to determine how far the cancer has spread. Lymph nodes are often the first place head and neck cancers spread.

Knowing whether the cancer has spread to the lymph nodes and surrounding tissue can help doctors determine whether radiation therapy or chemotherapy should follow surgery.

Recovery from surgery varies, depending on the type of procedure performed and whether reconstructive surgery is necessary. For example, if surgeons use an endoscopic approach for an early cancer, you may be able to go home the same day, with two or three days of recovery. Larger tumors that are removed endoscopically may require a hospital stay of a couple of days, so your pain and discomfort can be managed with medication. If extensive surgery and reconstruction are needed, the hospital stay may be longer, and recovery at home may last several weeks.

During recovery, you may meet with our doctors at NYU Langone’s Rusk Rehabilitation. They offer speech and swallowing therapy.