Our Head and Neck surgeons are highly experienced and well known to provide cutting-edge surgical care for head and neck cancers, maximizing cancer control while preserving function and appearance. Innovative surgical techniques for Head and Neck Cancers include:
CO2 Laser surgeries for organ and function preservation
For early vocal cord and laryngeal cancers (voice box cancer) treatment of choice is laser resection of the vocal cord with minimal thermal damage. This is achieved with endoscopic CO2 laser resection. There is no external cut, the neck surgery is done from inside the oral cavity. The advantage of this procedure is that “patient can be discharged the next day and can resume work within few days”. This procedure has got minimal side effects with good voice preservation. CO2 laser surgeries at Dharamshila Hospital are a boom for patients of North India. If CO2 laser surgery is not possible,voice conserving open surgeries are performed, Preserving the voice of a person.
Conservative resections are done for early cancers of the oral cavity. Main objective is to preserve organs and attain good quality of life for the patient. For early tongue cancers only wide excision with reconstruction can be done. For lesions of buccal mucosa (Inner lining of cheek) only resection and preservation of part of mandible (marginal mandibulectomy) can be done. This can be achieved with good results using CO2 laser for surgical Resection. For cancers of upper gum only removal of part of maxillary bone can be done with prosthodontic rehabilitation.
These extensive surgeries are done for locally advanced tumours of oral cavity (mouth) which are caused by tobacco chewing and are very common in south Asia (India). This involves removal of part of jaw / whole jaw with adjoining buccal mucosa (Inner lining of cheek) with or without removal of skin of cheek. Removal depends on adequate margin of resection.
For cancer of tongue, removal of tongue is done with or without removal of jaw and along with this neck dissection (removal of lymph glands in neck) is done. The gap appearing after the resection is repaired by plastic surgery (local / regional / free flaps). After that patient is rehabilitated by physiotherapist, prosthodontic surgeon, speech and swallowing therapist.
For cancers of cheek bone (maxilla), radical maxillectomy is done, which involves removal of cheek bone (maxilla) with or without preservation of eye depending on involvement of eye or not. If, cheek skin is involved, that is also removed. These tumours may extend to skull base i.e. near the brain, Resection involves removal of the tumour with preservation of vital nerves, which is technically demanding and involves team of experienced Head And Neck Cancer Surgeons. Neuro Surgeons, Plastic and Reconstructive Surgeons, to achieve good cancer control and good functional and cosmetic outcome.
Tumours arising from head and neck region reaching to base of the skull, require combined facial and craniotomy (opening of the skull) approach for their removal to get best surgical outcome. This technique was started at Dharamshila Hospital And Research Centre in 2000 and has been continuously refined to prevent recurrences and give good quality of life to patients.
These challenging surgeries for advanced loco-regional tumours of the jaw, involve removing the entire tumour including jaw, neck dissection for removal of lymph nodes, removing fibula (leg bone) of the patient and reconstructing the jaw with fibula. This is done to ensure that patient’s original appearance is maintained and functions of chewing, swallowing and speech are preserved. In this fibular reconstructed Jaw, dentures can be put at later date, so that patient can chew.
Free Flap Reconstruction is a novel plastic reconstruction technique. After cancer resection (removal), large gaps appear in the resected part of the body, which have to be reconstructed by using skin / muscle / bone of the patient. Before the surgery, the part of the body of the patient is chosen as a donor area, ensuring that it aptly matches the area being resected. After taking the graft from the donor area, it is harvested and used for replacing the gap caused by resection. Bone is replaced by a bone from area, where it has minimal function.
This also involves anastomoses (re-joining) of very small blood vessels to restore blood supply and joining of nerves to restore sensory and motor functions of the body. High magnification microscope and very fine sutures (thinner than hair) are used for anastomoses. This procedure is very technically demanding and takes 4 – 10 hours. Dharamshila Narayana Superspeciality Hospital is performing these surgeries regularly with very good results.
Carotid Body Tumours arise from the carotid artery (main artery supplying blood to the brain). These tumours may restrict blood supply to the brain. Resection of these tumours is technically demanding because if blood supply to the brain is hampered, the patient will have hemiplegia (paralysis of half body) or even death. Dharamshila Narayana Superspeciality Hospital is performing resection of carotid body tumours regularly with high success rate.
Nerve sheath tumours arise from the sheath that covers the major nerve trunks of any part of the body. The major challenge lies in removing these tumours without sacrificing and damaging the nerves and preserving the functions of the body parts, supplied by the nerves.
Parapharyngeal tumours arise from and around major vessels (carotid) and nerves coming out from the brain. Major blood vessels and nerves are important for sustenance of life. So, removal of these tumours involves preservation of these vital structures and is a challenging surgery, requiring highly skilled professionals. Dharamshila Narayana Superspeciality Hospital is the only hospital in North India performing these surgeries.
There is hope for patients with advanced cancer of the Larynx (Voice box). Treatment of choice is Total Laryngectomy, a procedure by which the voice box is totally removed. To restore the speech and communication, patients are trained on voice prosthesis or Electro larynx. All patients are suitably rehabilitated and satisfied by our team at Dharamshila Narayana Superspeciality Hospital.
Our radiation oncologists offer a range of therapies designed to shrink or destroy tumors while protecting normal tissue. Advanced technologies include:
Intensity-modulated radiation therapy (IMRT) uses advanced computer software to create beam configurations that “paint” target areas with more radiation in order to maximize tumor destruction while sparing normal tissue
Stereotactic radiosurgery (SRS), a form of radiation that uses several converging beams to focus a large dose of radiation on the tumor.
High dose rate brachy therapy in which radioactive seeds are introduced via catheter to tumor sites and radiation is administered from the inside out, resulting in a very precise therapy that focuses radiation on the tumor and spares surrounding normal tissue. Brachytherapy implants are placed in the operating room at tumor margins to enhance tumor destruction
Intraoperative radiation therapy allows the application of additional radiation therapy to be delivered at the time of surgical resection
Medical oncologists incorporate conventional therapies, investigational drugs, and targeted agents into treatment strategies customized to provide the most successful outcome for each patient. We have a special focus on incorporating targeted agents into concurrent chemo-radiation treatment approaches in order to maximize cure rates and minimize side effects of treatment for advanced head and neck cancers.