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ENT Procedures

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Throat Cancer (Transoral Surgery)
 
ENT ProceduresCancer that occurs in the larynx (voice box) and pharynx (throat), which includes the base of the tongue and tonsils, is commonly called throat cancer. It usually develops in adults over 50; men are 10 times more likely to develop the disease.1 Worldwide, there are about 290,000 cases of throat cancer each year.2

A neck and throat exam may show the presence of cancer. The sputum (what is coughed up) may appear bloody and a lump may appear on the outside of the neck.1 Symptoms may include abnormal-sounding breathing; coughing; neck or throat pain; or difficulty swallowing.1

It is important to be aware of the signs and symptoms of throat cancer since it is highly curable when found early.1 Studies show people with a history of tobacco and alcohol dependence have a higher rate of throat cancer.1 Smokeless tobacco products are not a safe substitute for smoking; harmful health effects may include throat cancer.3

Treatment
After a diagnosis is made and the stage (extent) of the cancer determined, your doctor will suggest appropriate treatment options. The goal of treatment is to eradicate the cancer and prevent it from spreading. Treatment options include surgery, chemotherapy and radiation, often applied in combination.4 In some cases, high-dose chemoradiation is given without surgery.4 This treatment is non-invasive but the resulting side effects may permanently impact your long-term ability to speak, swallow and eat normally. In fact, up to 30% of patients treated with chemoradiation alone may require a permanent feeding tube.5

If your doctor recommends surgery, there are two primary types: open and transoral (through the mouth). Tumor size, stage and location determine the type of surgery required.

No Incisions and No Scars with da Vinci Transoral Surgery at Touro Potential Benefits of da Vinci Transoral Surgery at Touro
Traditional open surgery to remove throat cancer typically requires your surgeon to make a long incision through the jaw and throat. Your surgeon may also need to break the jawbone to access the tumor. This approach can result in disfigurement as well as difficulty eating, speaking and swallowing.1 Reconstructive or plastic surgery may be needed to rebuild the bones or tissues removed during treatment.

Transoral laser surgery may provide a much less invasive treatment option. Using a surgical camera and microscope passed through the mouth, the surgeon directs the laser to the tumor location - avoiding the need for facial disfigurement and tracheotomy.4 This approach also may minimize or eliminate the need for chemoradiation and its potential side-effects. However, surgeons are limited by line-of-sight, instrumentation and optics - which means this approach may not be appropriate for all cases.

If your doctor recommends surgery to treat throat cancer, you may be a candidate for da Vinci Transoral Surgery — a safe and effective minimally invasive procedure. The da Vinci System enables your doctor to perform this delicate operation for early-to-moderate stage cancer. da Vinci provides your surgeon with superior vision, precision, dexterity and improved access. It thereby avoids the disfiguring and traumatic aspects of traditional surgery.6,7

da Vinci Surgery offers throat cancer patients numerous potential benefits over traditional treatments, including:

Surgery offers throat cancer patients numerous potential benefits over traditional treatments, including:
  • Significantly less blood loss5,6,7,8

  • No visible scarring or disfigurement6

  • No tracheotomy6

  • Minimization or elimination of need for chemoradiation therapy6,7

  • Fewer complications5

  • Shorter hospital stay5,8

  • Fast recovery, return to normal speech and swallowing5

  • Excellent cancer control5

As with any surgery, these benefits cannot be guaranteed, as surgery is patient- and procedure-specific. 

Sleep Apnea

The Greek word "apnea" literally means "without breath." There are three types of apnea: obstructive, central, and mixed; of the three, obstructive is the most common. Despite the difference in the root cause of each type, in all three, people with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.

Obstructive sleep apnea (OSA) is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. In central sleep apnea, the airway is not blocked but the brain fails to signal the muscles to breathe. Mixed apnea, as the name implies, is a combination of the two. With each apnea event, the brain briefly arouses people with sleep apnea in order for them to resume breathing, but consequently sleep is extremely fragmented and of poor quality.

Treatment for Sleep Apnea
Lifestyle changes, mouthpieces, breathing devices, and surgery are used to treat sleep apnea. Lifestyle changes and/or mouthpieces may be enough to relieve mild sleep apnea. People who have moderate or severe sleep apnea may need breathing devices or surgery.

The standard breathing device treatment for sleep apnea is to wear a CPAP mask, which improves the opening of the breathing passages by blowing pressurized air into the patient’s nose or mouth during inhalation, overcoming the tissue collapse that creates the apnea. The alternative to CPAP is surgery. Traditionally, surgery has been centered on a procedure known as uvulopalatopharyngoplasty (UPPP), which includes removing the tonsils and trimming the palate.

Tissue obstruction occurs at the base of the tongue in addition to the palate and tonsils. The tongue base obstruction component of sleep apnea may be one of the reasons why surgery on the tonsils and palate alone does not always work. There have been various supplemental surgical procedures that have been devised to address the tongue base component and improve the success of a UPPP.

Minimally invasive surgery with the da Vinci can be used to treat candidates who have tongue base level obstruction causing sleep apnea.

Patients are assessed through in-office examination, review of recent sleep studies, and evaluated with a scope to identify the levels of tissue obstruction. If the tongue base is involved, then the patient is a candidate for sleep apnea using the da Vinci system.

The Sleep Apnea procedure involves the surgery and a 1-2 day post-operative hospitalization. Full recovery is expected to take about three weeks. A post-surgical sleep study is obtained three months after surgery.
 
 

1www.nlm.nih.gov/medlineplus/ency/article/001042.htm. 2”Global Cancer Statistics, 2002”; A Cancer Journal for Clinicians; American Cancer Society; www.caonline.amcancersoc. org 3www.cancer.org/docroot/PED/content/PED_10_13X_Quitting_Smokeless_Tobacco.asp?sitearea=PED. 4mayoclinic.org/throat-cancer/treatment.html. 5Weinstein GS, O’Malley Jr BS, Desai SC, Quon H; Transoral robotic surgery: does the ends justify the means? Current Opinion in Otolaryngology & Head and Neck Surgery,17:126–131, 2009 6O’Malley Jr. B, Weinstein GS, Snyder W, Hockstein, NG; Transoral Robotic Surgery (TORS) for Base Tongue Neoplasms, Laryngoscope 116: August 2006. 7Weinstein GS, O’Malley Jr. BW, Synder W, Sherman E, Quon H; Transoral Robotic Surgery, Radical Tonsillectomy; Arch Otolaryngol. Head Neck Surg/Vol. 133 (No. 12), Dec 2007. 8Boudreaux BA, Rosenthal EL, Magnuson SJ, Newman RJ,, Desmond RA, Clemons L, Carroll WR; Robot-Assisted Surgery for Upper Aerodigestive Tract Neoplasms; Arch Otolaryngol Head Neck Surg/Vol 135 (No. 4), Apr 2009 

While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

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