Head And Neck Surgery
Head And Neck Surgery
Jason Hamilton (Facial Plastic & Reconstructive Surgeon) gives expert video advice on: What material is used for reconstruction of the face, head and neck?; Is it safe for children to have plastic or reconstructive surgery? and more...
What types of head and neck surgery do otolaryngologists perform?
Otolaryngologists perform head and neck surgery which involves removal of tumors from anywhere in the head and neck region. This includes the tongue, the voice box, the thyroid gland, parathyroid gland, salivary glands, including the submandibular and parotid glands, tumors of the ear, tumors that involve the eye, and they work in coordination with neurosurgeons to remove tumors that involve the brain or the base of the skull as well.
What is a "facial plastic and reconstructive surgeon"?
A facial plastic and reconstructive surgeon is a plastic surgeon who limits themselves to working only on the face and neck regions. They have a broad training in facial plastic surgery, including reconstructive surgery, which means correction of cleft lips and cleft palates, congenital nasal defects and congenital anomalies involving the ear or the jawbone or the face. They're highly trained in treating those disorders. A facial plastic surgeon also has training in micro-vascular surgery, where they can take tissue from other parts of the body, such as the arms, legs, back, thighs – and transferring that to the head/neck region reconstruct defects in those areas. The facial plastic surgeon also has expert training in cosmetic procedures that involve the face and neck regions. The speciality came about because typically, when patients are being treated for any disorder of the face and neck, they don't want you to put incisions in conspicuous places; so they have to be hidden. That's where the facial plastics part of it grew from.
What are the advantages to consulting a facial plastic and reconstructive surgeon?
The advantage of seeing a facial plastic surgeon for procedures you want on your face is that they have experience not only in cosmetic procedures but in functional procedures as well. So facial platic surgeons are not just treating patients who want a rhinoplasty to look better, they're treating patients with sleep apnea, who have problems with breathing or snoring. Facial plastic surgeons' requirement in their training for procedures is vast, so they may have to do hundreds of nasal surgeries before they are allowed to graduate from their residency, and I think that gives them an advantage over the other plastic surgeons in treating the face.
What type of surgeries do specialists in facial plastic and reconstructive surgery perform?
Otolaryngologists who practice facial plastic and reconstructive surgery actually provide a wide variety of procedures. That does include rhinoplasties, reconstruction of facial bones from trauma or from cancer surgeries. They also do cosmetic work as well, such as facelifts, eye rejuvenation, forehead lifts, lip implants. Facial plastic surgeons also work in conjunction with pediatric otolaryngologists on patients who have congenital deficits, meaning they may have a small ear, or be missing part of their lip or nose or eyelid or something of that nature, and they'll help to reconstruct those areas as well.
What material is used for reconstruction of the face, head and neck?
Typically, facial abnormalities are reconstructed either with local skin or bone in the area that has a deficit, or tissue can be transferred from other parts of the body, such as the leg, the thigh, the arm, to the head and neck region to reconstruct an area. A common example is patients who have tumors involving the jawbone. If part of the jawbone is removed, some of the fibula will be taken, with its artery and vein, from the leg, along with skin, and used to rebuild a new jawbone, and the arteries and veins will be sewn back together in the head and neck region to provide the patient with a stable new jawbone.
Where does a facial plastic and reconstructive surgeon hide incisions?
I think in the face, the areas that different units of the face meet one another are good places to hide incisions. So where the ear meets the face, you can hide incisions behind the ear in the creases. You can hide incisions around the nostrils, where the nose meets the cheek. A lot of procedures are done endoscopically, with hidden incisions, so a forehead lift now can be done with small incisions in the scalp. You can do a face lift with small incisions behind the ear. It can be done endoscopically. Cheek implants can be placed not necessarily through the eyelid, but under the lip, so that the incisions are hidden. All the rhinoplasty incisions are hidden on the inside of the nostril, and the incisions for chin implants or liposuction can be placed inside the mouth, or in little creases or maybe cuts or lacerations that patients already have.
Is it safe for children to have plastic or reconstructive surgery?
Absolutely. The facial plastic surgeon takes into consideration the growth of the patient. So typically, surgeries are staged, meaning that either the patient will have to wait to have a surgery when they reach the appropriate age. For example, we know that the human ear reaches almost adult size by the time a child is five to six years old. So any ear reconstruction, we'll wait until the child is five or six. At that time, the ear is about 90 percent its adult size and can be reconstructed and there's no fear of the child outgrowing the size of the ear. For nasal surgeries, typically a rhinoplasty or a nasal reconstruction, we'll wait until the child reaches late puberty because the nose is typically adult size around 13 to 15 in a female, and about 16 to 18 in a male. So the age of the child is taken into consideration, but it doesn't preclude any reconstructive efforts.
What kinds of non-invasive procedures do facial plastic and reconstructive surgeons perform?
The other thing about facial plastic surgery is that we do a lot of non-invasive things, too. So, for patients who are not really interested in surgery, I think the advantage over a dermatologist would be that we use Botox, we use facial fillers, and we use laser therapy. There are some non-ablative lasers that can just resurface and tighten the skin for non-surgical face lifting. At the same time, sort of like the general otolaryngologist who has a medical arm and a surgical arm, we're also surgeons, and eventually the fillers are not going to continue to work. Eventually there's going to be a little nip and tuck that's needed. You're seeing the same physician who you're comfortable with for your non-invasive procedures and you can move right into doing more invasive things, or surgical procedures, with the same physician, and I think that's the advantage.
How do otolaryngologists who specialize in facial surgery differ from other plastic surgeons?
Facial plastic surgeons differ from general plastic surgeons in their training and their focus. Facial plastic surgeons train for five years on the head and neck, which includes basic training of facial plastic surgery and trauma. They continue their training in facial plastic surgery itself for a total of six years of training just in the face and neck regions. The general plastic surgeons do five years of general surgery and then they do two years of plastic surgery, which encompasses the entire body. So, in those two years, there is a small focus on each section of the body. Their total time in the head and neck region may be three to four months. Some of them go on to do a fellowship in cosmetic surgery where, again, they do the whole body. I think the advantage of the facial plastic surgeon is that they've had over six-plus years of just training in the facial region. They've treated the face and neck for functional as well as for cosmetic issues, and I think that gives them an advantage over dermatologists or general plastic surgeons in treating that area.