Most tumors of the salivary gland are benign and occur in the parotid glands. Surgery to remove the tumor is among the most effective treatment methods for salivary gland tumors.

Parotidectomy with Facial Nerve Dissection (superficial or total)

Parotidectomy is the surgical removal of the parotid gland, which is the major and largest salivary gland.  In most cases, this requires identification and dissection of the facial nerve (the nerve responsible for movement of the face).  When performed by an experienced surgeon, this is a very safe procedure with low risk of complication.

Excision of the submandibular gland

The surgical removal of the submandibular gland, a major salivary gland present in the left and right chin regions.  This is generally performed for either tumors or chronic infection.  

Cancers of the larynx, pharynx, trachea and esophagus can be managed either surgically or non-surgically (with radiation therapy with or without chemotherapy) depending on type, location, and stage of tumor.  In addition to managing tumors of these areas, Dr. Anfuso also manages several other conditions as mentioned below.

Laryngectomy 

Apartial laryngectomy is a surgical procedure on the voice box designed to preserve the voice. The surgeon removes part of the voice box - one vocal cord, part of a cord, or the epiglottis - and leaves the rest.

Endoscopic partial laryngectomy, in contrast to open laryngectomy, allows for maximal preservation of normal tissue, faster tolerance of an oral diet (often within one or two days of surgery), no incisions and no need for tracheotomy.

Total laryngectomy - this is a procedure that removes the entire voicebox.  After the procedure, a person breathes only through a small hole in their neck and no longer breathes through their mouth and nose.  Patients are able to eat normally through their mouth.  The ability to speak is temporarily lost, but speech can be restored through additional surgical procedures and speech therapy.

In general, total laryngectomies are only performed for advanced cancers of the voicebox or if nonsurgical treatment has already failed to cure the cancer. We realize this is a life-changing procedure.  We will thoroughly educate you on the procedure itself and what to expect after surgery. In addition, we will arrange for pre-laryngectomy education with a speech and swallow therapist prior to your surgery.

Tracheostomy

A tracheostomy is a surgical incision in the windpipe made to relieve an obstruction to breathing.

Laryngoscopy/pharyngoscopy/esophagoscopy with endoscopic excision of lesions

A laryngoscopy is an examination that allows your doctor to look at the back of your throat, your voice box and vocal cords with an instrument called a laryngoscope.

A pharyngoscopy is a procedure used to examine the back of the throat for abnormal tissue.

An esophagoscopy uses a thin, lighted tube inserted through the mouth into the esophagus to look for abnormal tissue. An endoscopic excision of lesions is the surgical removal of abnormal tissue using an endoscope. 

Vocal cord injection (for vocal cord paralysis)

A vocal cord injection is a very simple procedure that can help improve voice quality in patients with vocal cord paralysis.  This procedure takes only a few minutes and does not require admission to the hospital.   It is performed through the mouth without the use of any incisions.

Zenkers diverticulotomy/diverticulectomy (open vs endoscopic)

Zenker’s diverticulum is an abnormality where a muscle of the upper esophagus (cricopharyngeus) becomes abnormally thickened leading to difficulty with swallowing. Over time, a pouch can form above this thickened muscle, and food can accumulate in this pouch and later be coughed up.   Treatment involves cutting this thickened muscle and sometimes removing the pouch. Most of the time this can be performed endoscopically through the mouth.  Rarely, an external neck incision is required.

Sinus or nasal cancers are rare head and neck tumors that form in the tissues of the paranasal sinuses and nasal cavity. In general, surgery is the treatment of choice. Surgical procedures to remove cancer in the nose and sinuses include: 

Maxillectomy 

Maxillectomy is the surgical removal of all or part of the maxilla bone, the upper jaw. It is used to remove tumors of the hard palate, nose, maxillary sinus or other tumors that have grown in the jaw area. A total maxillectomy is the surgical removal of the entire maxilla, and a partial maxillectomy is the surgical removal of only part of the maxilla. An endoscopic maxillectomy is a less invasive process that can be an alternative technique to open maxillectomy for some tumors.

A pharyngoscopy is a procedure used to examine the back of the throat for abnormal tissue. 

An esophagoscopy uses a thin, lighted tube inserted through the mouth into the esophagus to look for abnormal tissue. An endoscopic excision of lesions is the surgical removal of abnormal tissue using an endoscope. 

Vocal Cord Injection (for vocal cord paralysis)

A vocal cord injection is a very simple procedure that can help improve voice quality in patients with vocal cord paralysis.  This procedure takes only a few minutes and does not require admission to the hospital.   It is performed through the mouth without the use of any incisions.

Zenkers Diverticulotomy/Diverticulectomy (open vs endoscopic)

Zenker’s diverticulum is an abnormality where a muscle of the upper esophagus (cricopharyngeus) becomes abnormally thickened leading to difficulty with swallowing. Over time, a pouch can form above this thickened muscle, and food can accumulate in this pouch and later be coughed up.   Treatment involves cutting this thickened muscle and sometimes removing the pouch. Most of the time this can be performed endoscopically through the mouth.  Rarely, an external neck incision is required. 

Neck surgery describes any surgical procedure that is performed on the neck area of the body. 

Neck Dissection (selective, modified radical, and radical)

In cancers of the head and neck, the first area of spread is most often to the lymph nodes of the neck. At the time of your surgery, in addition to removal of the tumor, removal of the lymph nodes of the neck is often required.  This requires an incision within a skin crease of the neck and placement of a drain in the neck that can be removed in a few days.  Most of the time, only the lymph nodes within the neck are removed, and all importance structures such as muscles, nerves, arteries, and veins are left in place.  In most cases, no deficits should be expected after surgery.

Excision of Carotid Body Tumors

A carotid body tumor is a rare type of tumor located in the neck along the carotid artery.  In most cases, these tumors are not malignant. Surgical excision is the recommended treatment.

Excision of Thyroglossal Duct Cysts

A thyroglossal duct cyst is a congenital abnormal defect (present at birth) that is predominantly diagnosed in children. Thyroglossal duct and cyst removal is a surgical procedure that involves removing an abnormal mass or lump that has developed on the thyroglossal duct (anywhere from under the tongue, to the lower half of the neck).

Excision of Branchial Cleft Cysts

A branchial cleft cyst is an abnormal cavity that is a present at birth on one side of the neck and is located on either side of the neck running from just behind the ear down to the collarbone. Excision of branchial cleft cysts is the surgical removal of the abnormal tissue. The operation is usually done as a day surgery procedure under general anesthesia.

Excision of Laryngoceles

A laryngocele is an air-filled bulge in the neck resulting in hoarseness and airway obstruction. It may also cause a visible lump in the neck.  These may be treated endoscopically through the mouth or via an external neck incision.

Sometimes, after a tumor has been removed, reconstruction may be necessary in order to restore speech and swallowing, repair a large defect or optimize cosmetic appearance.  Reconstructive techniques include the following:

Skin Grafts

Skin grafting is a type of surgery involving the transplantation of a very thin layer of skin from one area of the body (most commonly the thigh) to another.   This can be used to repair small defects of the head and neck.

Local Flaps

Locals flaps are most commonly skin flaps used to repair nearby skin defects.

Pedicle Flaps

Pedicle flaps, also known as an attached flap, is a section of tissue with its blood supply intact that is moved to another part of the body. 

Paramedian forehead flap is a surgical technique where tissue from the forehead is used most often to reconstruct different kinds of nasal defects.   

Pectoralis major muscular or myocutaneous flap is a surgical procedure where the skin and/or muscle of the chest is used to repair large defects of the head and neck, mostly in the neck or throat region.

Microvascular Free Flaps

Microvascular free flaps are the transplantation of tissue from one site of the body to another in order to reconstruct a defect. This is the best available method to reconstruct large defects of the head and neck region. Important structures such as the tongue, throat, and jaw bone can be rebuilt using tissue from the forearm, thigh, or leg.   

Thyroidectomy (hemi vs total)

A thyroidectomy is the partial or complete removal of the thyroid gland.  This is most commonly performed for cancer of the thyroid gland or for any large thyroid gland causing swallowing or breathing issues.  This procedure requires the identification of two critical structures: The nerve that moves the vocal cords (recurrent laryngeal nerve) and the glands that make calcium (parathyroid glands).  In experienced hands, this surgery has very low risk of complications with a quick recovery time.  A patient will be left with only a small scar in the midline of the neck that heals nicely.

Parathyroidectomy

Parathyroidectomy is the surgical removal of one or more parathyroid glands.  This procedure is most often performed for a condition called hyperparathyroidism which leads to elevated calcium levels.  In experienced hands, this surgery has very low risk of complications with a quick recovery time.  A patient will be left with only a small scar in the midline of the neck that heals nicely.

Central Neck Dissection

Rarely, thyroid cancer can spread to the lymph nodes in the central next surrounding the thyroid gland.   A central neck dissection is a removal of these abnormal lymph nodes.