Atlas of Head and Neck Surgery

Visit the link below to download the full version of this book:

https://medidownload.com/product/atlas-of-head-and-neck-surgery-2/

Click Download Now

Editors
Ricard Simo Paul Pracy
Department of Otorhinolaryngology Head and Department of Otorhinolaryngology
Neck Surgery University Hospitals Birmingham NHS
Guy’s and St Thomas’ Hospital NHS Foundation Foundation Trust
Trust London, UK
London, UK

Rui Fernandes
Division of Head and Neck Surgery, Department
of Maxillofacial Surgery
University of Florida Health
Jacksonville, FL, USA

ISSN 2626-9015     ISSN 2626-9023 (electronic)

Springer Surgery Atlas Series
ISBN 978-3-031-36592-8    ISBN 978-3-031-36593-5 (eBook)
https://doi.org/10.1007/978-3-031-36593-5

© Springer Nature Switzerland AG 2024

This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

If disposing of this product, please recycle the paper.

Preface

Head and neck surgery is a rapidly developing surgical specialty. It is certainly unique, as over
the years, surgeons have subspecialised in head and neck surgery coming from multiple surgi-
cal disciplines including (in alphabetical order) general surgery, oral and maxillofacial surgery,
otorhinolaryngology and plastic surgery. Over the past few years, head and neck surgical fel-
lowships have been created both nationally and internationally for surgeons of different surgi-
cal disciplines to be trained in this “subspecialty”.
In many specialised tertiary centres, head and neck surgery represents a specialty of its own
and can employ surgeons from all the feeding surgical core disciplines to work together.
The head and neck region is a complex and challenging anatomical area. Surgeons are treat-
ing pathology of 15 different anatomical subsites with multiple histopathological tumour
types.
Head and neck surgery has significantly evolved over the last 20 years, and the turn of the
century has seen significant improvements in all areas ranging from minimally invasive sur-
gery including transoral laser and robotic surgery, and major ablative surgery with free flap
reconstruction both in the primary and salvage setting. All these surgeries offer high success
rates of cure with minimal complications in expert hands.
This textbook addresses the core procedures of this specialty in a manner that will help resi-
dents and young surgeons to understand the critical steps of each procedure and apply them
into surgical practice in a safe and structured way.
We have chosen worldwide experts on each procedure, tried to combine expertise from dif-
ferent parts of the globe with the help of a Fellow to provide a balanced view of how these
surgical procedures are carried out in a safe way.
We are confident that this textbook will serve its purpose to help not only young surgeons
of around the world of the different specialties but also nurses and allied health professionals
to understand the basic principles of head and neck surgical procedures.
Finally, we would like to thank Springer for having the trust, confidence and encouragement
to see this project to fruition.

London, UK Ricard Simo

Birmingham, UK  Paul Pracy
Jacksonville, FL, USA  Rui Fernandes

v
Contents

Part I Adult Endoscopy

1 Clinical Diagnostic Nasopharyngolaryngoscopy�����������������������������������������������������   3

Nicholas Gibbins and Hugo Galera-Ruiz
2 Transnasal Oesophagoscopy and Advanced Applications��������������������������������������� 23
Yakubu Karagama, Aina Brunet-Garcia, Natalie A. Watson, and Asit Arora
3 
Operative Pharyngoscopy and Laryngoscopy (Microlaryngoscopy)��������������������� 35
Natalie A. Watson, Anthony Aymat, Elfy Chevretton, and Yakubu Karagama

Part II Airway Surgery

4 
Percutaneous Tracheostomy and Open Standard Surgical Tracheostomy����������� 47
Kenneth Muscat and Sanjai Sood
5 Tracheal and Cricotracheal Resection and Anastomosis for Subglottic
and/or Proximal Tracheal Stenoses��������������������������������������������������������������������������� 57
Davide Lancini, Alberto Paderno, and Cesare Piazza
6 
Surgery for Vocal Fold Immobility��������������������������������������������������������������������������� 69
Declan Costello, Gauthier Desuter, and Julie T. van Lith-Bijl

Part III Benign and Diagnostic Neck Surgery

7 
Incision and Drainage of Deep Neck Space Infections ������������������������������������������� 85
Francis Vaz, Aleix Rovira-Casa, and Andrew Dias
8 
Lymph Node Excision Biopsy ����������������������������������������������������������������������������������� 91
Victoria Harries and Ashley Hay
9 Thyroglossal Duct Cyst����������������������������������������������������������������������������������������������� 101
Kartic Rajaram, Joel Smith, and Omar Hilmi

Part IV Pharyngeal Pouch Surgery

10 
Endoscopic Approaches to the Pharyngeal Pouch: Stapling Technique ��������������� 111
Sandro J. Stoeckli, Gerhard F. Huber, and Neil Sharma
11 
Open Approach to Pharyngeal Pouch and Cricopharyngeal Myotomy ��������������� 117
Jemy Jose and R. James A. England

vii
viii Contents

Part V Neck Dissection

12 Radical
 and Modified Radical Neck Dissection������������������������������������������������������� 123
Anthony Brian Powell Morlandt and Anil D’Cruz
13 Functional Neck Dissection ��������������������������������������������������������������������������������������� 129
Laura Rodrigáñez, Alejandro Castro, and Javier Gavilán
14 Sentinel
 Lymph Node Dissection������������������������������������������������������������������������������� 139
Clare Schilling and Raja Sawhney

Part VI Salivary Gland Surgery: Parotid Gland Surgery

15 Transoral
 Removal of Salivary Stones ��������������������������������������������������������������������� 149
Oskar Edkins and Johannes J. Fagan
16 Partial
 Parotidectomy Including Deep Lobe and Dumb Bell Tumours����������������� 159
Nick Roland, Maria Casasayas, and Miquel Quer
17 Total
 Conservative and Radical Parotidectomy������������������������������������������������������� 169
Vincent Vander Poorten and Michael Elliott

Part VII Salivary Gland Surgery: Submandibular Gland Surgery

18 Transoral
 Removal of Intracanalicular Stones in the Submandibular Glands���� 181
Jonathan B. Gottlieb and Luke Cascarini
19 Submandibular Gland Excision��������������������������������������������������������������������������������� 191
Oliver Kaschke and Marius Schulz-Schönhagen

Part VIII Salivary Gland Surgery: Sublingual Gland Surgery

20 Intraoral
 Excision of Ranula������������������������������������������������������������������������������������� 199
Johannes J. Fagan and Kevin G. Smith
21 Transcervical
 Excision of Ranula ����������������������������������������������������������������������������� 203
Johannes J. Fagan and Kevin G. Smith
22 Parapharyngeal Space Tumour Excision����������������������������������������������������������������� 207
Johannes A. Rijken, Carsten E. Palme, and C. René Leemans

Part IX Lip Surgery

23 Lip Shave (Vermilionectomy)������������������������������������������������������������������������������������� 217

Marek J. Ogledzki and Carlos A. Ramirez
24 V
 and W Lip Excisions����������������������������������������������������������������������������������������������� 227
Brian Bisase and Ara Chalian
25 Lip
 Reconstruction with Local Flaps ����������������������������������������������������������������������� 231
Richard Chalmers and Omar A. Ahmed

Part X Oral Cavity Surgery

26 Transoral Partial Glossectomy ��������������������������������������������������������������������������������� 243

Arpan Tahim and Zaid Sadiq
Contents ix

27 
Floor of the Mouth Cancer����������������������������������������������������������������������������������������� 251
Alaistar Fry and Leo Vassiliou
28 
Excision of Palatal Neoplasms����������������������������������������������������������������������������������� 257
Allison A. Slijepcevic, Daniel Petrisor, and Mark K. Wax
29 
Inferior Maxillectomy and Resection of Tumour of the Upper Alveolus��������������� 271
Adam P. Fagin, Daniel Petrisor, and Peter A. Brennan

Part XI Surgery of the Mandible

30 Perioral Marginal Mandibulectomy������������������������������������������������������������������������� 285

Joshua E. Lubek
31 
Composite Resection and Segmental Mandibulectomy������������������������������������������� 293
Brian Cervenka, Luke Cascarini, and Michael G. Moore

Part XII Access for Oral Cavity Tumour Surgery

32 Access Procedures: Visor Flap, Lip Split, Mandibulotomy,

and Lingual Release��������������������������������������������������������������������������������������������������� 305
Omar Breik, Matthew Idle, and Timothy Martin

Part XIII Oropharynx

33 Standard Tonsillectomy ��������������������������������������������������������������������������������������������� 321

Jason C. Fleming and Trevor G. Hackman
34 
Transoral Resection for Oropharyngeal Neoplasms����������������������������������������������� 329
Mario Fernández, Terry M. Jones, and Katharine Davies
35 Robotic Surgery ��������������������������������������������������������������������������������������������������������� 345
Somiah Siddiq, F. Christopher Holsinger, and Vinidh Paleri

Part XIV Laryngeal Surgery: Transoral Approaches

36 
Transoral Laser Resection for Glottic and Supraglottic Tumours������������������������� 361
Laura Warner, Isabel Vilaseca, and James O’Hara

Part XV Laryngeal Surgery: Open Approaches

37 Total Laryngectomy��������������������������������������������������������������������������������������������������� 373

Hans Edmund Eckel and Miquel Quer
38 Vertical Partial Laryngectomy����������������������������������������������������������������������������������� 385
Phoebe Roche and Jonathan M. Bernstein
39 Horizontal Partial Supracricoid Laryngectomy with Crico-Hyoidopexy
or Crico-Hyoido-Epiglottopexy��������������������������������������������������������������������������������� 389
Giovanni Succo, Giuseppe Rizzotto, and Erika Crosetti

Part XVI Laryngeal Surgery: Voice Restoration

40 
Voice Restoration Following Laryngectomy������������������������������������������������������������� 403
Akshat Malik and Peter Clarke
x Contents

Part XVII Maxilla, Nose, and Paranasal Sinuses Surgery

41 Endoscopic
 Resection of Nasal and Paranasal Sinus Neoplasms��������������������������� 411
Pavol Surda, David Ranford, Steve Connor, Philip Touska, Luigi Volpini,
and Abigail Walker
42 Maxillectomy��������������������������������������������������������������������������������������������������������������� 431
Karl Payne, Omar Breik, Prav Praveen, and Sat Parmar
43 Craniofacial Resection����������������������������������������������������������������������������������������������� 451
Navin Mani and Jarrod J. Homer

Part XVIII Thyroid Surgery

44 Total
 Unilateral Lobectomy and Isthmusectomy����������������������������������������������������� 463
Peter Loizou, Brian Fish, and Faruque Riffat
45 Isthmusectomy and Subtotal Thyroidectomy����������������������������������������������������������� 469
Katherine Black and Johnathan Hubbard
46 Total
 Thyroidectomy with Level VI and VII Neck Dissection�������������������������������� 477
Christopher Fundakowski, Iain J. Nixon, Dipti Kamani,
and Gregory W. Randolph
47 Video-Assisted and Robotic Thyroidectomy������������������������������������������������������������� 485
George Garas, Conrad Timon, and Neil Tolley
48 Surgery
 for Intrathoracic Goitres����������������������������������������������������������������������������� 507
Ricard Simó, Iain J. Nixon, and Karen Harrison-Phipps

Part XIX Parathyroid Surgery

49 Bilateral Exploration Parathyroidectomy ��������������������������������������������������������������� 519

F. Fausto Palazzo and Antonio Sitges-Serra

Part XX Principles of free Flap Reconstruction in Head and Neck

50 Principles
 of Soft Tissue Free Flap Reconstruction in Head
and Neck Cancer��������������������������������������������������������������������������������������������������������� 527
Laura M. Cabañas Weisz and William A. Townley
51 Bony
 Reconstruction in the Head and Neck������������������������������������������������������������� 547
James Higginson, Omar Breik, Matthew Idle, Prav Praveen, Timothy Martin,
and Sat Parmar
Index������������������������������������������������������������������������������������������������������������������������������������� 571
Contributors

Omar A. Ahmed Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon
Tyne, UK
Asit Arora Department of Head and Neck Surgery, Guy’s and St Thomas’s NHS Foundation
Trust, London, UK
Anthony Aymat Department of Ear, Nose and Throat Surgery, University Hospital Lewisham,
London, UK
Jonathan M. Bernstein Department of Otolaryngology–Head and Neck Surgery, Imperial
College Healthcare NHS Trust, Charing Cross Hospital, London, UK
Brian Bisase Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital National
Health Service (NHS) Foundation Trust, East Grinstead, West Sussex, UK
Katherine Black Department of General Surgery, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
Omar Breik Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women’s
Hospital, University of Queensland, Brisbane, QLD, Australia
Peter A. Brennan Department of Oral and Maxillofacial Surgery, Portsmouth Hospitals NHS
Trust, Queen Alexandra Hospital, Portsmouth, UK
Aina Brunet-Garcia Department of Otorhinolaryngology and Head and Neck Surgery, Guy’s
and St Thomas NHS Foundation Trust, London, UK
Laura M. Cabañas Weisz Marques de Valdecilla University Hospital, Santander, Spain
Cirugia Plastica Bilbao Clinic, Bilbao, Spain
Maria Casasayas Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau,
Universitat Autònoma de Barcelona, Barcelona, Spain
Luke Cascarini Department of Oral and Maxillofacial, Head and Neck Surgery, Guy’s
Hospital, London, UK
Alejandro Castro Department of Otorhinolaryngology—Head and Neck Surgery, La Paz
University Hospital, Madrid, Spain
Brian Cervenka Department of Otolaryngology—Head and Neck Surgery, University of
Cincinnati School of Medicine, Cincinnati, OH, USA
Ara Chalian Department of Otorhinolaryngology, Penn Medicine, Philadelphia, PA, USA
Richard Chalmers Department of Plastic and Reconstructive Surgery, University Hospital of
North Durham, Durham, UK
Elfy Chevretton Department of Ear, Nose and Throat Surgery, Guy’s and St Thomas’s NHS
Foundation Trust, London, UK

xi
xii Contributors

Peter Clarke Faculty of Medicine, Faculty of Medicine Centre, Imperial College NHS Trust,
London, UK
Steve Connor Department of Neuroradiology, King’s College Hospital, London, UK
Declan Costello King Edward VII’s Hospital, London, UK
Erika Crosetti Head and Neck Oncology Unit, FPO IRCCS, Candiolo Cancer Institute,
Turin, Italy
Anil D’Cruz Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai,
Maharashtra, India
Katharine Davies Liverpool Head & Neck Centre, Liverpool University Hospital NHS
Foundation Trust, Liverpool, UK
Gauthier Desuter Voice and Swallowing Clinic, Department of Otolaryngology Head and
Neck Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
Andrew Dias South Infirmary Victoria University Hospital, Cork, Ireland
Hans Edmund Eckel Department of Oto-Rhino-Laryngology, Klinikum Klagenfurt am
Wörthersee, Klagenfurt am Wörthersee, Austria
Oskar Edkins Division of Otolaryngology, University of Cape Town, Groote Schuur Hospital,
Observatory, Cape Town, South Africa
Michael Elliott Department of Otolaryngology, Head and Neck Surgery, Chris O’Brien
Lifehouse, Sydney, NSW, Australia
R. James A. England Department of Otorhinolaryngology, Head and Neck Surgery, Hull and
East Yorkshire Hospitals NHS Trust, Hull, UK
Johannes J. Fagan Division of Otolaryngology, University of Cape Town, Groote Schuur
Hospital, Observatory, Cape Town, South Africa
Adam P. Fagin Department of Oral and Maxillofacial Surgery, Oregon Health and Science
University, Portland, OR, USA
Mario Fernández Department of Otorhinolaryngology, Hospital Universitario “Gregorio
Marañón”, Universidad Complutense de Madrid, Madrid, Spain
Brian Fish Department of Otolaryngology and Head and Neck Surgery, Addenbrooke’s
Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
Jason C. Fleming Liverpool Head and Neck Centre, Liverpool University Hospitals NHS
Foundation Trust, Liverpool, UK
Alaistar Fry Department of Otolaryngology and Head and Neck Surgery, Guy’s and St
Thomas’ NHS Foundation Trust, London, UK
Christopher Fundakowski Department of Otolaryngology-Head and Neck Surgery, Thomas
Jefferson University, Philadelphia, PA, USA
Hugo Galera-Ruiz Department of Otolaryngology, Hospital Universitario Virgen Macarena,
Sevilla, Spain
George Garas Department of Otorhinolaryngology and Head and Neck Surgery, Imperial
College London, St. Mary’s Hospital, London, England, UK
Head & Neck Surgical Oncology Unit, Queen Elizabeth Hospital Birmingham, University
Hospitals Birmingham NHS Foundation Trust, Birmingham, England, UK
Contributors xiii

Javier Gavilán Department of Otorhinolaryngology—Head and Neck Surgery, La Paz

University Hospital, Madrid, Spain
Nicholas Gibbins University Hospital Lewisham, London, UK
Jonathan B. Gottlieb Salivary Gland Service, The Oral and Maxillofacial Surgery Unit,
Carmel Medical Center, Haifa, Israel
Trevor G. Hackman Department of Otolaryngology/Head and Neck Surgery, G108
Physicians, Chapel Hill, NC, USA
Victoria Harries Department of Otolaryngology, University Hospitals Bristol NHS
Foundation Trust, Bristol, UK
Karen Harrison-Phipps Department of Otolaryngology and Head and Neck Surgery, Guy’s
and St Thomas’ NHS Foundation Trust, London, UK
Ashley Hay Department of Otolaryngology, University of Edinburgh, NHS Lothian’s
University Hospitals Division, Edinburgh, Scotland
James Higginson Department of Surgery and Cancer, Imperial College London, London, UK
Omar Hilmi Department of Otolaryngology, Glasgow Royal Infirmary, Glasgow, UK
F. Christopher Holsinger Division of Head and Neck Surgery, Department of Otolaryngology,
Stanford University, Palo Alto, CA, USA
Jarrod J. Homer Department of Otolaryngology-Head and Neck Surgery, Manchester
Academic Health Sciences Centre, Manchester, UK
Johnathan Hubbard Department of General Surgery, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
Gerhard F. Huber Department of Otorhinolaryngology, Head and Neck Surgery,
Kantonsspital St. Gallen, St. Gallen, Switzerland
Matthew Idle University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth
Hospital Birmingham, Birmingham, UK
Terry M. Jones Department of Molecular and Clinical Cancer Medicine, Liverpool Head and
Neck Centre, University of Liverpool, Liverpool, UK
Jemy Jose Department of ENT, Hull University Teaching Hospitals NHS Trust, Castle Hill
Hospital, Cottingham, UK
Dipti Kamani Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology,
Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
Yakubu Karagama Department of Ear, Nose and Throat Surgery, Guy’s and St Thomas’s
NHS Foundation Trust, London, UK
ENT Department, Guy’s Hospital, London, UK
Oliver Kaschke Department of Head and Neck Surgery, Sankt Gertrauden-Krankenhaus,
Berlin, Germany
Davide Lancini Unit of Otorhinolaryngology—Head and Neck Surgery, ASST—Spedali
Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and
Public Health University of Brescia, Brescia, Italy
C. René Leemans Department of Otolaryngology–Head and Neck Surgery, Amsterdam
University Medical Centres, Cancer Center Amsterdam, VU University, Amsterdam, The
Netherlands
xiv Contributors

Peter Loizou Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital,
Sydney, Australia
Joshua E. Lubek Department of Oral and Maxillofacial Surgery, Head & Neck Surgical
Oncology/Microvascular Reconstructive Surgery, University of Maryland, Baltimore, MD,
USA
Akshat Malik Max Super Speciality Hospital, Saket (Max Saket), New Delhi, Delhi, India
Navin Mani Central Manchester University Hospitals, University of Manchester, Manchester,
UK
Timothy Martin University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth
Hospital Birmingham, Birmingham, UK
Michael G. Moore Division of Head and Neck Surgery, Department of Otolaryngology,
University of California, Davis School of Medicine, Sacramento, CA, USA
Anthony Brian Powell Morlandt Section of Oral Oncology, Department of Oral and
Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
Kenneth Muscat Department of Otorhinolaryngology-Head and Neck Surgery, Mater Dei
Hospital, Msida, Malta
Iain J. Nixon Department of Otolaryngology-Head and Neck Surgery, NHS Lothian,
University of Edinburgh, Edinburgh, UK
James O’Hara Department of Otolaryngology, The Freeman Hospital, Newcastle upon Tyne,
UK
Marek J. Ogledzki Department of Oral/Maxillofacial Surgery, Ascension St. John Hospital,
Warren, MI, USA
Alberto Paderno Unit of Otorhinolaryngology—Head and Neck Surgery, ASST—Spedali
Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and
Public Health University of Brescia, Brescia, Italy
F. Fausto Palazzo Department of Thyroid and Endocrine Surgery, Hammersmith Hospital
and Imperial College London, London, UK
Vinidh Paleri Division of Head and Neck Surgery, The Royal Marsden NHS Foundation
Trust & The Institute of Cancer Research, London, UK
Carsten E. Palme Department of Head and Neck Surgery, Crown Princess Mary Cancer
Centre, Westmead Hospital, Westmead, NSW, Australia
Sat Parmar Department of Oral and Maxillofacial/Head and Neck Surgery, Queen Elizabeth
Hospital, Birmingham, UK
Karl Payne Institute of Cancer and Genomic Sciences, University of Birmingham,
Birmingham, UK
Trust, Manchester, UK
Vincent Vander Poorten Department of Oncology, Section Head and Neck Oncology;
Otorhinolaryngology–Head and Neck Surgery, University Hospitals Leuven, KU Leuven,
Leuven, Belgium
Carlos A. Ramirez Department of Oral/Maxillofacial Surgery, Ascension St. John Hospital,
Warren, MI, USA
Gregory W. Randolph Department of Otolaryngology Head and Neck Surgery, Harvard
Medical School, Boston, MA, USA
Contributors xv

David Ranford ENT Department, Guy’s and St Thomas’ University Hospital, London, UK
Faruque Riffat Westmead Private Hospital, University of Sydney, Bella Vista, NSW, Australia
Johannes A. Rijken Department of Head and Neck Surgical Oncology, University Medical
Center Utrecht, Utrecht, The Netherlands
Giuseppe Rizzotto Otolaryngology Department Unit, Vittorio Veneto Hospital, Treviso, Italy
Phoebe Roche Department of Otolaryngology–Head and Neck Surgery, Royal London
Hospital, Barts Health NHS Trust, Head & Neck Academic Centre, London, UK
Department of Targeted Intervention, University College London, London, UK
Laura Rodrigáñez Department of Otorhinolaryngology—Head and Neck Surgery, La Paz
University Hospital, Madrid, Spain
Nick Roland Aintree University Hospital NHS Trust, Liverpool, UK
Aleix Rovira-Casa ENT Department, Guy’s and St Thomas’ NHS Foundation Trust, London,
UK
Zaid Sadiq Oral and Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, UK
Raja Sawhney Lotus Dermatology/Center for Aesthetic Plastic Surgery, Brooksville, FL,
USA
Clare Schilling Department of Head and Neck Surgery, University College London Hospital,
London, UK
Marius Schulz-Schönhagen ENT and Head and Neck Surgery, Sankt Gertrauden
Krankenhaus, Berlin, Germany
Neil Sharma Department of Otorhinolaryngology, Head and Neck Surgery, University
Hospital Birmingham, Birmingham, UK
Somiah Siddiq Division of Head and Neck Surgery, Department of Otolaryngology,
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Ricard Simó Head, Neck and Thyroid Oncology Unit, Department of Otorhinolaryngology
Head and Neck Surgery, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, UK
Antonio Sitges-Serra Department of Surgery, Hospital del Mar, Barcelona, Spain
Allison A. Slijepcevic Department of Otolaryngology, Wake Forest University, Winston
Salem, NC, USA
Joel Smith Department of ENT, Head, Neck and Thyroid Surgery, Royal Devon and Exeter
Foundation Trust, Nuffield Health, Exeter Hospital, Exeter, UK
Kevin G. Smith Department of Otolaryngology–Head and Neck Surgery, North Shore
Hospital, Auckland, New Zealand
Sanjai Sood Department of Otorhinolaryngology–Head and Neck Surgery, Bradford Teaching
Hospitals NHS Trust, Bradford, UK
Sandro J. Stoeckli Department of Otorhinolaryngology, Head and Neck Surgery,
Kantonsspital St. Gallen, St. Gallen, Switzerland
Giovanni Succo Department of Otolaryngology–Head and Neck Surgery, University of
Turin–Oncology Department, San Giovanni Bosco Hospital, Turin, Italy
Pavol Surda ENT Department, Guy’s and St Thomas’ University Hospital, London, UK
xvi Contributors

Arpan Tahim Department of Head and Neck Surgery, University College London Hospital,
London, UK
Conrad Timon Department of Otorhinolaryngology and Head and Neck Surgery, Trinity
College Dublin, St. James’s Hospital, Dublin, Ireland
Neil Tolley Department of Otorhinolaryngology and Head and Neck Surgery, Imperial
College London, St. Mary’s Hospital, London, UK
Philip Touska Department of Radiology, Guy’s and St. Thomas’ NHS Foundation Trust,
London, UK
William A. Townley Department of Plastic Surgery, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
Julie T. van Lith-Bijl Flevoziekenhuis, Almere, The Netherlands
Cliniques Universitaire Saint-Luc, Brussels, Belgium
Leo Vassiliou Department of Oral Maxillofacial Surgery, Royal Blackburn Hospital, East
Lancashire Hospitals Trust (ELHT), Blackburn, UK
Francis Vaz University College London Hospital (UCLH), London, UK
Isabel Vilaseca Department of Otorhinolaryngology, University of Barcelona, Hospital
Clinic, Barcelona, Spain
Luigi Volpini Department of Otolaryngology, Head and Neck Surgery, Hywel Dda University
Health Board, Glangwili General Hospital, Carmarthen, UK
Abigail Walker ENT Department, Guy’s and St Thomas’ University Hospital, London, UK
Royal Brisbane and Women’s Hospital, New Farm, QLD, Australia
Laura Warner Department of Ear, Nose and Throat, Head and Neck Cancer, Freeman
Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Natalie A. Watson ST8 Otolaryngology, Guy’s and St Thomas’s NHS Foundation Trust,
London, UK
Department of Ear, Nose and Throat Surgery, Guy’s and St Thomas’s NHS Foundation Trust,
London, UK
Mark K. Wax Département Otolaryngology, OHSU, Portland, USA
 Part I
Adult Endoscopy
 Clinical Diagnostic
Nasopharyngolaryngoscopy 1
Nicholas Gibbins and Hugo Galera-Ruiz

1.1 Introduction 6 mm endoscopes equipped with a built-in working chan-

nel for passage of a flexible biopsy forceps or a laser fibre.
History and examination will always remain the first line in Information from a chip in the distal tip of the endoscope
the diagnosis and treatment of any head and neck pathology. is sent to a video processor, which creates a digital image
Inspection and palpation must be followed by a thorough and enables high-resolution imaging. The scope usually
examination of the mucosal surfaces of the head and neck. has some components that remain constant: the control
For this, the flexible nasopharyngolaryngoscope is an essen- with the up/down angulation system and different buttons
tial piece of equipment for the head and neck surgeon. (white balance, photo/video recording, etc.), flexible end
Flexible nasopharyngolaryngoscopy (FN) of the head and section, the light cable, and the digital image cable which
neck has revolutionised otolaryngology and allows detailed connects to the monitor/screen.
examination of the naso-, oro-, and hypopharynx as well as • Video processor system.
the larynx in relative comfort for the patient and with a high • High-resolution monitor/screen (4 K).
degree of definition. A quick, accurate diagnosis helps guide • Capture imaging system for photo/video documentation.
the surgeon towards appropriate investigations and formulat- An additional advantage of digital endoscopic techniques
ing an individualised treatment plan. is the possibility of recording images, enabling more
This chapter will also briefly discuss more recent extended detailed reporting in the patient’s electronic file and com-
uses of the endoscope that have become more commonplace, parison of images during follow-up.
such as transnasal oesophagoscopy, using a channelled endo- • Light source (LED).
scope to perform in-office biopsies or treatments, or using • Decontamination system: enzymatic detergent, glutaral-
alternate imaging modalities that have been more recently dehyde, or a noncorrosive solution, based on brand and
pioneered that may help with the diagnosis of mucosal manufacturer recommendations.
lesions. • Topical decongestant.
• Anaesthetic spray.
• Lubricating gel.
1.2 Equipment • Antifog solution or alcohol wipes.
• Tissues.
To perform FN, it is necessary to have certain equipment,
which includes the following material: If biopsy, endoscopic procedures, or Fibre-optic
Endoscopic Evaluation of Swallowing (FESS) are being per-
• Digital FN with chip-on tip technology of varying diam- formed in office, the following are also required: adequate
eter sizes ranging from 1.9 mm for paediatric use to the forceps or instrumentation, 5 cc Lüer-lock syringe, an aspira-
tion system and liquids, thick liquids (nectar and honey-like),
puree, solids, and mixed consistencies.
N. Gibbins (*)
University Hospital Lewisham, London, UK FN remains difficult to perform in resource-limited set-
e-mail: [email protected] tings due to the high cost of purchasing and maintaining
H. Galera-Ruiz equipment as well as the need for specialists to interpret
Department of Otolaryngology, Hospital Universitario Virgen exam findings. The lack of expertise can be obviated by
Macarena, Sevilla, Spain adopting telemedicine-based approaches [1] and the capture,
e-mail: [email protected]

© Springer Nature Switzerland AG 2024 3

R. Simo et al. (eds.), Atlas of Head and Neck Surgery, Springer Surgery Atlas Series,
https://doi.org/10.1007/978-3-031-36593-5_1
4 N. Gibbins and H. Galera-Ruiz

storage, and sharing of images/video can be replaced by a 1.4 Use of Endoscope

smartphone that can fulfil the same functions but at a lower
cost [2]. In Head and Neck Oncology, the use of the FN in the evalu-
Institutions without the high-definition equipment ation of patients is used mainly by ENT and Maxillofacial
detailed above usually rely on the older flexible fibrescopes. surgeons or by trained physicians who manage the upper air-
These can be connected via a separate attachable camera way in the operating room or the intensive care unit setting.
head to a stack system if photographic or video documenta- It is also useful in voice consultation, and as part of the FEES
tion is needed. in conjunction with the speech and language therapists.
FEES allows the examiner to identify swallowing physiol-
ogy, determine the safest and least restrictive level of oral
1.3 Set-Up intake, implement appropriate compensatory techniques,
and identify a dysphagia rehabilitation plan [3]. FN is gener-
The visualisation of the mucosal surfaces of the upper ally well tolerated by adults, infants, and children.
aerodigestive tract (UADT) necessitates a clear image unhin- The appropriate care of the FN is of utmost importance;
dered by either equipment, patient, or operator factors. To therefore, all users should be familiar with proper cleaning
obtain the best view, the variables about examination must be and storage. Scopes are sturdy but not indestructible; thus,
kept to a minimum. To this end, the patient must be still and bending the scope at tight angles should be avoided and
so must be properly anaesthetised and comfortable. The high-level decontamination achieved before and after usage
operator must also be adept at anaesthetising the patient suf- as required depending on brand and manufacturer. Storage
ficiently, operating the equipment, and performing the must be in a safe place.
procedure. Sterile disposable sheaths are custom-built for a variety of
Anaesthetising the patient’s UADT sufficiently to gain a scopes and models and even come with a working channel.
clear view of anatomy is important. This allows visualisation The tip of the sheath must be fully slid onto the scope so that
of the laryngeal ventricles, subglottis, and post-cricoid areas the special optical element at the end lies flat against the tip
that can be very difficult to approach endoscopically without of the scope. Nowadays, with the advent of the Covid-19
anaesthesia. pandemic, even disposable single use scopes are readily
Many options are available. However, the basic tenets of available at low prices for its use whenever necessary.
decongestion and time should be adhered to. Decongestion
of the nose is helpful to allow easy passage of the endoscope
through the nose, and sufficient time must be allowed for the 1.5 Aims of Endoscopy
anaesthetic to work—the speed of response to topical anaes-
thesia in the general population is a bell-shaped curve—and 1.5.1 TNM and Cancer Mapping
it may take 10–15 min for some patients to be completely
anaesthetised. When performing endoscopy, one needs to think about the
The patient should be sat in a chair with a head rest and an information that is needed from the examination. This
ability to lie flat in the case of a vaso-vagal attack. If one is will be complementing the history that has already been
not available, then a chair pushed back against the wall is a taken to allow accurate and individualised management
reasonable alternative. The head rest or wall restricts the plans to be formed. In the case of benign pathology, the
patient’s head from moving during examination. questions that need answering may include “is the vocal
The operator should stand in front of the patient. If seated, fold cyst epithelial or epidermoid?’ The answer to this
the operator should come alongside the patient with the lat- may not be obvious unless other visualisation modalities
eral aspect of both operator’s and patient’s knees in proxim- are employed such as stroboscopy (Sect. 1.7.2). It will
ity (i.e. right knee to right knee). Sitting in front of the patient also change the surgical planning. If the pathology is pap-
means the operator has to lean forward to gain a view putting illomatosis, the question will be “how extensive is the dis-
undue strain on the back. ease?” This will ensure that the correct visualisation
Ideally, there will be a screen to view the endoscopic techniques are used such as ensuring a view into the tra-
image on as per the equipment list above. This should be chea and subglottis. In the case of potentially malignant
placed next to the patient facing the operator so that the clini- pathology, the extent of disease is a major factor in the
cian does not have to turn their head to see it. If the operator prognosis as it is a constituent part of the TNM classifica-
is looking down an eye-piece, then the second eye should be tion. For example being able to see into the laryngeal ven-
kept open—this will allow the operator to see any movement tricles or subglottis may allow the differentiation of a T1a
of the patient and adjust accordingly. and a T2 cancer of the larynx.
1 Clinical Diagnostic Nasopharyngolaryngoscopy 5

Table 1.1 T staging of laryngeal cancer for the public • Cleanliness of the lens
Tis (tumour in situ) the cancer is very early. It is contained in the top –– Focus
layer of the skin like covering of the larynx (mucosa). It has not –– White balance
spread into any surrounding tissue –– Image centred on the area of interest
T1 the tumour is only in one part of the larynx, and the vocal cords
are able to move normally
T2 the tumour, which may have started on the vocal cords (glottis), Factors that cannot be altered by the clinician include
above the vocal cords (supraglottis), or below the vocal cords
(subglottis), has grown into second part of the larynx • Resolution of the camera and screen
T3 the tumour is more bulky and has caused one of the vocal cords • Quality of the endoscope
to not move (your doctor may describe it as fixed). OR the tumour
has grown into nearby areas such as the tissue in front of the
epiglottis (pre-epiglottis tissues) or the inner part of the thyroid Therefore, before starting endoscopy, one should check
cartilage the equipment (including recording equipment if being used)
T4 means the tumour has grown into body tissues outside the larynx. and the area you are using for endoscopy. The three main
It may have spread to the thyroid gland, windpipe (trachea), or food areas to check are the endoscope itself, the position of the
pipe (oesophagus)
examiner, and the processor, if being used. The processor or
light source is turned on, the patient’s details entered, and the
The latest iteration of the TNM classification for head and strobe or NBI adjuncts checked if they are to be used (dis-
neck cancers can be ordered via the UICC website (https:// cussed later in the chapter).
www.uicc.org/news/8th-­e dition-­u icc-­t nm-­c lassification-­ The endoscope is plugged in, the image is focussed, is
malignant-­tumors-­published) and should be available in aligned on the monitor, and finally white balanced. One can
every cancer centre (Table 1.1). Cancer Research UK has an also colour check endoscopes with a test chart if this is
overview of all the TNM classifications for head and neck available.
cancer in their easy-to-use website here: https://www.can- Finally, the examiners put themselves in a comfortable
cerresearchuk.org/about-­cancer/head-­neck-­cancer. position, either standing or sitting, with your head in a posi-
For any suspected cancer, good visualisation with esti- tion so that you can see the patient and the monitor screen at
mated measurements of the lesion and an accurate position is the same time. If you are using an eyepiece endoscope rather
essential. This will give clinical information to add to the than a monitor, you should learn to perform the examination
radiological and histological findings. In some cases, accu- with both eyes open so that the non-dominant eye will pick
rate visualisation will give more information than radiologi- up movements or cues from the patient during examination.
cal investigation. For example the knowledge that a cancer It takes very little time to learn when the image you have
has spread from the vocal fold into the ventricle or subglottis is either too bright or dark, or unfocussed, or rotated, or the
can be accurately assessed with endoscopy but may not be lens has fluid on it. All these aspects can be quickly corrected
easily demonstrated on cross-sectional imaging. and will give you an excellent image.
It is the author’s contention that having the ability to put Endoscopes with side-channels have a greater diameter
these clinical pictures forward at an MDT discussion gives a (up to 6 mm) but can still pass through the nose of adults
clear picture of the lesion being discussed. Some imaging with adequate decongestion and anaesthesia.
systems have the connective capability to upload the images
to the radiology imaging system so that they can be reviewed 1.6.1.1 Vaso-vagal Attack
in the same way that the patient’s scan can be. The clinician may come across a patient who will have a
vaso-vagal attack during endoscopy. The patient will start
feeling faint, and when you look at their face, they will have
1.6 Techniques for Visualization become very pallid. Lie the patient down on the floor imme-
diately to prevent syncope and lift their legs, resting them on
1.6.1 General a chair until they feel better. Usually, with time, the patient
can still have an endoscopy without having the same reac-
Indirect laryngoscopy involves multiple pieces of equipment tion. However, there will still be patients who will be unable
working synchronously combined with good operator tech- to have endoscopy without having a vaso-vagal attack. With
nique and the weakest point will determine the quality of the an amenable patient, it may be possible to perform FN with
image you get. the patient lying down (Fig. 1.1).
Factors that can affect the quality of your image, and that
can be easily checked and corrected if necessary, include 1.6.1.2 Holding the Endoscope
There are many types of endoscope on the market. Some are
• Level of illumination designed to be held in a specific way, and some can be held