Ear Nose and Throat
Ear, nose, and throat, often called ENT, is a surgical subspecialty within medicine that pertains to the diagnoses and medical and surgical treatments of disorders of the ears, nose, and throat.
Istanbul Med Assist partners work with leading experts in the field of ENT (otolaryngology).
What is Larynx Cancer?
Head and neck cancers constitute 5-7 percent of all body cancers. Larynx cancer also accounts for a quarter of this statistic. Larynx cancer means cancer of the vocal cord. While the most common causes are cigarette and alcohol consumption, in recent years, human papillomavirus (HPV), reflux, and the radiation effect of radiotherapy have also been included in the causes. While it is frequently seen in men who smoke, nowadays, it is also seen in women due to the increase in smoking. While the most common age for larynx cancer occurrence is 50-70 years, with the effect created by HPV and the spread of reflux among people, it has started to be seen at earlier ages.
Signs And Symptoms
The most common symptom of larynx cancer is hoarseness. In addition, pain in the throat, burning, stinging, and difficulty in swallowing in patients with advanced-stage larynx cancer, symptoms such as breathing difficulty, inability to eat, and advanced hoarseness may occur. Patients who come to us usually come with the complaint of hoarseness. A mass may appear on the neck. Sometimes, depending on the cancer's location, some patients come with a mass in the neck, that is, with metastasis, without any other symptoms.
Diagnosis Of Larynx Cancer
When patients arrive for the first time, indirect laryngoscopy, direct laryngoscopy, and endoscopic laryngoscopy are used for the diagnosis. With the help of cameras, the larynx and vocal cords are examined. The region that lowers the voice is detected.
When a suspicious lesion is seen, this lesion must be removed and sent to pathology. For this purpose, we do a biopsy for the patient in the operating room under general anesthesia. When performing a biopsy, there is no need for an external incision. It is not a complex procedure. After the patient is put to sleep, small biopsies are taken from the suspicious areas with the help of a microscope through the mouth.
As a result of these biopsies and the pathologist's examination, if laryngeal cancer is diagnosed, it is necessary to plan the treatment and understand the spread of the disease. The most common type is epidermoid cancer, with a 90 percent prevalence. Epidermoid cancer is the cancer of the epithelium that covers our larynx. After the diagnosis of laryngeal cancer, patients should be studied further.
Firstly, if a patient's biopsy has been done and a diagnosis of laryngeal cancer has been made, we need to know the spread of the disease. For this, neck MRI and whole-body PET CT are performed first. The spread of the disease is determined with the whole-body PET CT examination. With a neck MRI, it is understood in which parts of the larynx the disease has spread and its size. It is decided what kind of treatment plan will be made. From time to time, tomography can also be helpful because the roof that forms the outside of our larynx consists of cartilage. Tomography is one of the methods that show cartilage best.
Larynx Cancer Treatment
After the diagnosis of the disease and determination of its spread, the treatment phase starts. How much of the larynx remains intact is very important in treatment. In patients who come to us within the first few months, when the cancer is of small size, the entire treatment can be performed from within the mouth without making an external incision and without removing a large larynx fragment. Surgery is performed under general anesthesia in such patients using the micro laryngoscopy technique. By entering through the mouth, while the patient is sleeping, the cancerous parts of the throat are removed, and other areas are protected. And the voice and swallowing function of these patients is maintained.
However, this procedure may no longer work in intermediate and advanced-stage cancers. For this, more extensive surgical resections are required. Sometimes spread in lymph nodes in the neck is treated. If the disease is very advanced, for example, in the fourth stage, if there are distant metastases or suspicious areas such as lung, bone, or brain, it is possible to improve the patient's health with radiotherapy and chemotherapy after surgical treatment.
What is Thyroid Cancer
The thyroid gland is also known as the goiter gland. It is an organ located in the lower part of our neck, just above our rib cage, deep in our two neck muscles, and has very important functions in our lives. It constantly secretes hormones for the body, and this hormone is an essential hormone for a person’s daily life.
Sometimes masses may develop in the thyroid. These masses are the bumps inside the gland. That is, they are undesirable formations that come in different shapes.
Diagnosis Of Thyroid Cancer
These are usually diagnosed by ultrasound unless there is a huge mass. In ultrasound, the appearance of the mass in the gland, whether it is bad or good, and whether it is cancer or benign, is understood. When we see such a patient, the first requested examination is an ultrasound. Ultrasound enables the determination of the patient’s risk group according to the characteristics of the mass. If the mass has a benign ultrasound appearance, the risk does not exceed 5%. However, sometimes the appearance of the mass on ultrasound, calcification, and excessive blood supply may suggest that the mass is suspicious.
Suppose a thyroid nodule is more significant than one centimeter; a needle biopsy is requested, even if it has no bad characteristics. But even if it is smaller than one centimeter, a needle biopsy should still be done if there is anything suspicious on the ultrasound.
What is a needle biopsy? Let’s think of the thyroid gland as a walnut. In it, an ultrasound-guided needle is inserted into a chickpea-sized nodule, and a certain amount of liquid is taken from this chickpea. This liquid is spread on the glass, and its cells are examined. The pathologist gives us a risk ratio or makes a definitive diagnosis.
Thyroid Cancer Treatment
If the mass is benign, it can be followed. However, papillary cancer is the most common cancer in the thyroid gland, with a rate of 80%.
Surgery is recommended for patients if there is a risk of papillary or follicular cancer. In this case, surgery is inevitable. The entire thyroid gland consists of two lobes. Right and left lobes. If one side is entirely healthy, we try to maintain its function by removing the diseased side only and leaving the healthy side in the body.
Because this gland has essential functions, when taken in its entirety, the hormone necessary for the body must be taken in pill form. This is how planning is done. If both lobes are thought to be cancerous, usually, all of the two lobes are removed. Then, if necessary, we treat the masses in this area with radioactive iodine treatments.
What is Salivary Gland Cancer
In our practice, one of the diseases we frequently encounter is salivary gland masses. Salivary glands comprise three large salivary glands, thousands of small salivary glands around our face, cheeks, and under the chin, and the mini salivary glands that line our entire mouth. The three major salivary glands are usually found in pairs. Salivary gland masses are generally benign. But the smaller the salivary gland, the more likely the mass will be malignant. The salivary glands in our cheeks are called the parotid salivary glands. 80% of the tumors in this area are benign. So, it has a benign character. Malignancy is lower. While tumors in the submandibular gland are a 60% to %40 ratios so, there is a 60% possibility it is benign, and 40% it is malignant. Masses in the sublingual salivary gland have a 60-70% chance of being cancer and a 30-40% chance of being benign. There are minor salivary glands of a few millimeters on our palate, all over our throat, on our tongue, and the floor of our mouth. Of most minor salivary gland masses, 80% are malignant, but 20% are benign. Salivary gland cancers are masses in our throat, cheeks, mouth, and chin.
Signs And Symptoms
Salivary glands are glands spread in the cheek around the mouth, under the chin, while minor salivary glands are distributed in the mouth's full throat, tongue, and floor. Generally, complaints related to them arise in the form of a mass. Rarely, in the salivary glands of the cheek or the salivary glands under the chin, namely, the parotid and submandibular glands, salivary gland tumors can occur with swelling in the gland as a result of the obstruction of the ducts in the gland. Since the tumors in this area are 80% benign, only cosmetic effect occurs. It occurs as a swelling in the cheek, under the chin, and a swollen and rough area in the mouth and palate. In addition, in advanced stages, if cancer progresses, especially in the cheek salivary glands, if the facial nerves just below the cheek are involved, there may be a loss of movement in the involved part of the nerve, as well as a loss of motion in your whole face. These are the first warnings. When a swelling is encountered on the face, cheek, or mouth, it is necessary to go to the doctor.
Diagnosis Of Salivary Gland Cancer
Most salivary gland masses occur on our face and under our chin. The patient, who sees swelling here, first comes to an ear, nose, throat, head, and neck surgeon. Most of the diagnosis in these areas is done by needle biopsy. This is usually done with ultrasound. The location and shape of the masses are determined with ultrasound. A small needle is inserted into the mass, and a small piece is taken. And this piece is placed on a piece of glass and sent to the pathology doctor. According to the pathology result, treatment planning is done for the area of the mass.
Salivary Gland Cancer Treatment
If it is a benign mass or in the cheek area, an operation called superficial parotidectomy is performed. The feature of this surgery is this: In this area, the facial nerve passes just below the mass. Therefore, the facial area should be monitored by nerve monitoring. It is necessary to know during surgery where we are, where we are in the tumor, and where the nerve is. As you know, since the facial nerve provides the movement of the whole face, if damage occurs to any of its branches, your lip might not move, the upper lip may not move, and your eye may not close. And the shape of the face may be distorted. Therefore, it is a necessary surgery. Even if the mass is benign, while the facial nerve is being monitored, the mass is cleaned and removed from above the facial nerve.
If the mass is malignant, it is necessary to be more careful. Both the mass is removed, and the facial nerve is preserved. Removing the remaining salivary glands under the facial nerve is also necessary. Because if the tumor is malignant, nothing should be left behind. Also, with neck dissection, lymph nodes in the neck should be included in this surgery. Because the salivary glands often spread to the neck lymph nodes on the same side. As a result of cleaning these lymph nodes, the patient will have a better recovery and prognosis. In the advanced stages of such tumors, radiotherapy and chemotherapy may be added to the treatment.
Breathing through the nose is an invariable part of our lives. When babies are born, they know how to breathe through the nose, not the mouth. We continue to breathe through the nose throughout our lives. But when we are stressed or need to walk quickly or run, we breathe through the mouth. Therefore, nasal congestion is very important in terms of quality of life.
The most common cause of nasal congestion is the curvature of the septum, which divides the nose into two, and growths in the nasal conchae. Since the nose is a widely used organ and constantly interacts with dust and air, deterioration or enlargement of the nasal concha may occur sometimes. In addition, allergies and weather conditions also affect the nasal conchae. The blows to the nose after birth and our genetic structure shape the nose until age 18. After taking its final shape at the age of 18-20, if there is a deformity or breathing problem, they should be treated.
Nasal Deformities Surgery
Breathing through the nose is improved, and the shape is corrected.
Deformities in the nose are treated with;
- Rhinoplasty if there is an apparent defect on the outside.
- Septoplasty if there is a defect inside the nose only
- Concha Surgery if the nasal conchae are large, they are corrected with surgeries for the conchae.
Rhinoplasty surgery is an operation in which by correcting the external shape of the nose reshaping the bones by cutting and rasping them, stitching the cartilage, and adding new cartilage, the nose is given a more beautiful appearance. At the same time, we create a good breathing function by correcting intranasal curvature with septoplasty in all these surgeries. In addition, if there is an enlargement in the nasal conchae, we definitely make an intervention. The nose is a complex anatomy and structure. It should always be preferred to be operated on by a good surgeon because it is an organ you will carry on your face for the rest of your life.
What is Chronic Sinusitis?
Chronic sinusitis is a sinus disease that lasts longer than three months. However, not every patient whose disease has passed three months is operated on immediately. Firstly, the patient’s diagnosis of chronic sinusitis has to be definite. For this, tomography is taken. The most useful technique in the diagnosis of chronic sinusitis is sinus tomography.
Chronic Sinusitis Treatment
When sinus tomography is taken, if the mucous membranes in the sinuses are thick, full of inflammation, and cannot be opened and cleaned, then surgery is considered. The most critical factor in the surgery decision is whether or not the sinus ostium that opens into the nose is closed. Chronic sinusitis may be associated with polyps, allergies, cystic fibrosis, cilia movement disorder, and inflammation and infection. When this happens, the treatment plan changes accordingly.
The treatment for chronic sinusitis is endoscopic sinus surgery. Protecting the patient’s nose, sinuses, and mucous membranes as much as possible ensures that the disease exits flowing from the sinuses to the nose in the best way or that the sinuses are ventilated. With endoscopy, treatment is performed by working inside the nose with a camera system, expanding the ostia of the sinuses. Here, the method called navigation that guides us is essential. Navigation, as it shows you how to find the way to your home, shows us how to enter the sinuses. It is the most helpful method for surgery in the sphenoid sinus, called the intracranial sinus, and the frontal sinus, called the forehead sinus.
In addition, a shaver is used. It can be thought of as a kind of shaving device. Especially when polyps are in the nose, it was impossible to work comfortably in the past due to both bleeding and the softness of the polyps. Now we open the sinus ostium more easily by aspirating the blood and shaving the polyps with the shaver device. And we get the result we want.