Surgical Specialties

Head and Neck Surgery encompasses a broad range of procedures from complex large cancer operations requiring reconstruction to removal of small skin lesions from the head or face.

Surgery may be required for either cancerous or non-cancerous conditions. The anatomy of the head and neck region represents the most complex in the human body. Surgery in this area can therefore have a significant impact on basic human functions such as eating, swallowing, speaking, breathing and facial expression. New techniques have evolved to assist the Head and Neck Surgeon in reducing this impact. Robotic Surgery or Transoral Robotic Surgery (TORS) is one such technique at the disposal of the Head and Neck Surgeon allowing a high definition view of anatomy and access to difficult areas.

Patients present to a Head and Neck Surgeon with a wide range of symptoms, often related to the basic human functions. Difficulty or pain on swallowing, change in voice, difficulty with breathing, pain in the throat or ear are all symptoms which need to be evaluated. A new neck lump which persists also needs to be assessed.

Transoral Robotic Surgery or TORS is a technique most commonly used by head and neck surgeons to remove cancers of the throat, including the tonsil and base of the tongue. It can also be used to remove non-cancerous growths from the head and neck without the need for visible incisions on the neck.

The robot is a state-of-the-art device with high precision instruments which the surgeon controls to perform the surgery. The surgeon obtains a high definition view of the surgical field and is able to see around corners and complete precise movements in extremely small spaces.

Prior to the introduction of TORS, surgeons often would need to split the jaw open or cut through the neck to access these areas of the throat. This would often result in slower recoveries from surgery and potentially more complications. To avoid these large, often morbid surgeries, treatment of these throat cancers shifted to the use of radiation and chemotherapy. These can have long-lasting irreversible side effects.

TORS allows the head and neck surgeon to provide patients with an effective treatment option for cancers of the head and neck whilst preserving function.

The Thyroid is a butterfly-shaped gland located at the bottom of the neck in front of our windpipe. It releases the hormone which helps to control our metabolism, growth, and development.

Thyroidectomy is the surgical removal of part or all of your thyroid gland. This may be required due to cancer, non-cancerous enlargement (Goitre) or due to overactivity (Grave’s Disease). The amount of thyroid that may need to be removed depends on the condition being treated.

Should all the Thyroid be removed then you will require thyroid hormone replacement daily for the rest of your life. If only part of the gland is removed, then the remaining portion may still function normally and provide adequate hormone.

The Thyroid gland is in close proximity to two nerves (one on each side) which supply the voice box. Injury to these nerves could result in a hoarse voice, difficulty breathing or aspiration. It is therefore important that Thyroidectomy is performed by an experienced surgeon.

The parathyroid glands (see Parathyroid Surgery) also lie close to or sometimes within the Thyroid gland. Injury to these glands during Thyroid surgery can result in low calcium levels and the requirement for supplementation.

For Thyroid surgery in Sydney contact Dr. Peter Floros.

We typically have four Parathyroid glands which are located low in the neck behind the Thyroid gland. They play an important role in regulating our bodies calcium levels.

The most common reason why you may require surgery for the Parathyroid glands is when they become overactive and enlarged. This condition is called hyperparathyroidism and is most frequently due to a single enlarged gland (Parathyroid Adenoma), but occasionally may be due to multiple glands.

Surgery to remove an enlarged, overactive gland requires a small incision low on the front of your neck in a crease. The enlarged/s Parathyroid gland/s are located at the back of the Thyroid and removed. Rarely part of the thyroid gland may need to be removed if the abnormal Parathyroid gland is located within the Thyroid gland itself.

The salivary glands make saliva and empty this into the mouth and throat through small openings. The major salivary glands are the most important as they secrete the majority of saliva.

We have 3 pairs of major salivary glands called the parotid, submandibular and sublingual glands.

• Parotid glands: located just in front and below the ear.
• Submandibular glands: located just below the jaw and are the size of a walnut.
• Sublingual glands: the smallest of the major glands and are located below the tongue on the floor of the mouth.

We have several hundred minor salivary glands in the head and neck most commonly located lining the lips, the tongue, roof of mouth, cheeks, sinuses and around the voice box.

Surgery for the salivary glands may be required to remove cancer, non-cancerous masses, salivary glands which frequently become infected or inflamed or rarely for other benign conditions.

The salivary glands especially the major ones are located near important nerves. Salivary Glands Surgery should be performed by an experienced Head and Neck Surgeon.

The most common reasons for surgery on the nose and sinuses are due to breathing problems, acute and chronic sinusitis which is unresponsive to medical treatment,  removal of polyps and as part of treatment for allergy. Surgery on the nose includes straightening on the nasal septum (Septoplasty) and reduction in the size of the turbinates (Turbinoplasty) with the goal of improving nasal airflow and breathing.

Sinus surgery or endoscopic sinus surgery (ESS) is a surgical procedure utilising a camera (endoscope) inside the nose without any external incisions to reestablish the draining pathways of the sinuses. This in turn helps medication to be delivered throughout the sinuses. It is important to realise that in some cases medical therapy will need to be continued despite having had sinus surgery. This may also be done in conjunction with other procedures such as Septoplasty or Turbinoplasty for breathing or to provide access to the sinuses.

The most common ear, nose and throat procedures on children include removal of the tonsils (tonsillectomy), removal of the adenoids (adenoidectomy) and grommet insertions.

Like tonsils, the adenoids play a role in the immune system by trapping bacteria and viruses. They are a pad of tissue that sits at the back of the nasal cavity (nose). In children they are most commonly removed for breathing and sleep problems such as snoring or sleep apnoea often in combination with tonsillectomy. They may also be removed due to recurrent infections and sinusitis.

Tonsillectomy or removal of the tonsils is a common procedure performed by Ear, Nose and Throat Surgeons on both children and adults. The tonsils are two oval shaped pads of tissue at the back of the throat. They function as the immune systems first line of defence against bacteria and viruses as they enter our mouth. This likely makes the tonsils prone to infection and inflammation. After puberty their immune function tends to decline, and it is important to realise that there is no impact on the immune system if they are removed.

In children today it is most commonly done for sleep problems (sleep disordered breathing) but also for repeated tonsil infections (Tonsillitis).

In adults they may be removed for recurrent tonsillitis, as part of treatment for sleep apnoea, due to a complication of tonsillitis such as abscess, due to concern for cancer or sometimes because of tonsil stones and bad breath.

The recovery time for Tonsillectomy is 2 weeks, with sometimes moderate to severe pain in the throat during this healing time. Bleeding following the operation is the most concerning risk and therefore it is important to have an experienced Ear, Nose and Throat Surgeon managing your care afterwards.

Grommets are most commonly inserted to treat fluid in the middle ear (glue ear) or prevent recurrent middle ear infections (recurrent acute otitis media). They may also be inserted due to speech and hearing problems in your child. Grommets are small hollow plastic tubes. They are inserted in the ear drum (tympanic membrane) to allow air into the middle ear and prevent build up of fluid.  In children this build up typically arises because the tube (Eustachian tube) connecting the ear and nose isn’t working properly.

The surgery typically involves a general anaesthetic but sometimes may be done in the office under local anaesthetic. A small cut is made in the ear drum and fluid suctioned out. The grommet is then inserted.

Depending on the type of grommet used they stay in the ear drum anywhere from 6-12 months. Occasionally they may be pushed out prematurely. The ear drum with time will push the grommet out and no further procedure is required. Rarely the grommet may need to be removed or especially in kids they may require further sets of grommets in the future if the Eustachian tube still hasn’t started to work.

Grommet surgery is a day procedure and patients can go home when they have recovered. It is uncommon to have significant pain after grommet surgery. It is important to realize that once they are inserted, a pathway between the external environment and middle ear has been created. Therefore prevention of water exposure is important including during bathing, swimming or hair washing. Keeping water out of the ear canal with plugs, blue tac, ear wraps and swimming caps is important.