Many surgical advances are being made in this area. Procedures such as tonsillectomy and facial plastic surgery are becoming less invasive, and new procedures are being developed to treat serious problems such as cleft palate, sleep apnea, and deafness.
Children and Facial Paralysis
…There are more than 50 known causes of facial paralysis but the most common in children is “Bell’s palsy,” the cause of which is not certain…
Children and Facial Paralysis
…There are more than 50 known causes of facial paralysis but the most common in children is “Bell’s palsy,” the cause of which is not certain…
About 40,000 people in the United States develop facial paralysis each year with children comprising a small percentage of that population. There are more than 50 known causes of facial paralysis but the most common in children is “Bell’s palsy,” the cause of which is not certain. This disorder effects one side of the facial muscles due to dysfunction of the seventh cranial nerve, usually thought to stem from a viral infection; Bell’s palsy is found in 20 out of 100,000 Americans, with the incidence increasing with each decade of life.
What causes Bell’s palsy?
In Bell’s palsy, facial paralysis results from damage (e.g., possibly from viral infection) to the facial nerve. Adults and children will either wake up to find they have facial paralysis or palsy, or have symptoms such as a dry eye or tingling around their lips that progress to Bell’s palsy during that same day. Occasionally symptoms may take a few days to progress to facial weakness or paralysis. Physical trauma to the head and neck region at birth and during childhood may cause facial paralysis. Other causes are:
- Chicken pox: Chicken pox and shingles are both caused by a single virus of the herpes family known as varicella-zoster virus (VZV). Varicella is the primary infection that causes chickenpox; Herpes zoster is the reactivation of the virus that causes shingles. Research studies suggest that Bell’s palsy may be due to a reactivation of herpes simplex virus (HSV). Between 75 percent and 90 percent of chickenpox cases occur in children under 10 years of age. According to a 2001 study, about 10 percent of children between ages five and nine and about two percent of 10 to 14 year olds get chicken pox each year.
- Infectious mononucleosis: This condition, with a peak incidence in the 15- 17 age group, can be caused by several different viruses. The leading causes are the Epstein-Barr virus and cytomegalovirus, both members of the herpes virus family. The infection is transmitted by saliva, sexual contact, respiratory droplets, and blood transfusions.
- Lyme disease: Lyme disease is an infection that’s spread by Ixodes ticks (black-legged or deer ticks in the eastern United States, and western black-legged ticks in the west). The second stage of Lyme disease usually appears two to three months after the tick bite, and may include facial palsy or paralysis among other symptoms.
What are the symptoms of Bell’s palsy in children?
Not all children react the same to this disorder. However, recorded symptoms include:
- The child may complain of headache or pain behind or in front of the ear a few days prior to the onset of Bell’s palsy.
- Swelling or drooping on one side of the face.
- Drooling, excessive, or reduced production of saliva.
- An inability to blink or completely close one eye.
- The child has either excessive tears or marked dryness and inability to make tears in one eye.
- Sounds seem louder than they really are.
- The child is experiencing sensitivity to light.
- Episodes of dizziness.
Treatments for Facial Paralysis:
If infection is the cause, then an antibiotic to fight bacteria (as in middle ear infections) or antiviral agents (to fight syndromes caused by viruses like herpes zoster (Ramsay Hunt Syndrome) may be used. The prognosis for children with facial paralysis is generally very good. The extent of nerve damage determines the extent of recovery. With or without treatment, studies indicate that most pediatric patients with the disorder begin to get better within two weeks after the initial onset of symptoms and recover completely within three to six months. Adults may find residual symptoms remaining for an indefinite period of time.
What happens during the diagnosis?
After an examination, the otolaryngologist- head and neck surgeon may conduct a hearing test to determine if the cause of damage to the nerve has involved the hearing nerve, inner ear, or delicate hearing mechanism. Additional tests in the physician’s office include a balance test and a tear test, to measure the eye’s ability to produce tears. Eye drops may be necessary to prevent drying of the surface of the eye cornea. In some circumstances, the physician may recommend a CT (computerized tomography) or MRI (magnetic resonance imaging) test to determine if there is infection, tumor, bone fracture, or other abnormality in the area of the facial nerve. An additional diagnostic tool is the Electro neuronography (ENOG), which stimulates the facial nerve to assess how badly the nerve is damaged. This test may have to be repeated at frequent intervals to see if the disease is progressing.
National Institute of Neurological Disorders and Stroke
Bell’s Palsy Research Foundation
Insight into causes and prevention
- What is dizziness?
- What causes dizziness?
- How will my dizziness be treated?
- and more…
Feeling unsteady or dizzy can be caused by many factors such as poor circulation, inner ear disease, medication usage, injury, infection, allergies, and/or neurological disease. Dizziness is treatable, but it is important for your doctor to help you determine the cause so that the correct treatment is implemented. While each person will be affected differently, symptoms that warrant a visit to the doctor include a high fever, severe headache, convulsions, ongoing vomiting, chest pain, heart palpitations, shortness of breath, inability to move an arm or leg, a change in vision or speech, or hearing loss.
What is dizziness?
Dizziness can be described in many ways, such as feeling lightheaded, unsteady, giddy, or feeling a floating sensation. Vertigo is a specific type of dizziness experienced as an illusion of movement of one’s self or the environment. Some experience dizziness in the form of motion sickness, a nauseating feeling brought on by the motion of riding in an airplane, a roller coaster, or a boat. Dizziness, vertigo, and motion sickness all relate to the sense of balance and equilibrium. Your sense of balance is maintained by a complex interaction of the following parts of the nervous system:
- The inner ear (also called the labyrinth), which monitors the directions of motion, such as turning, rolling, forward-backward, side-to-side, and up-and-down motions.
- The eyes, which monitor where the body is in space (i.e., upside down, right side up, etc.) and also directions of motion.
- The pressure receptors in the joints of the lower extremities and the spine, which tell what part of the body is down and touching the ground.
- The muscle and joint sensory receptors (also called proprioception) tell what parts of the body are moving.
- The central nervous system (the brain and spinal cord), which processes all the information from the four other systems to maintain balance and equilibrium.
The symptoms of motion sickness and dizziness appear when the central nervous system receives conflicting messages from the other four systems.
What causes dizziness?
Circulation: If your brain does not get enough blood flow, you feel lightheaded. Almost everyone has experienced this on occasion when standing up quickly from a lying-down position. But some people have light-headedness from poor circulation on a frequent or chronic basis. This could be caused by arteriosclerosis or hardening of the arteries, and it is commonly seen in patients who have high blood pressure, diabetes, or high levels of blood fats (cholesterol). It is sometimes seen in patients with inadequate cardiac (heart) function, hypoglycemia (low blood sugar), or anemia (low iron).
Certain drugs also decrease the blood flow to the brain, especially stimulants such as nicotine and caffeine. Excess salt in the diet also leads to poor circulation. Sometimes circulation is impaired by spasms in the arteries caused by emotional stress, anxiety, and tension.
If the inner ear fails to receive enough blood flow, the more specific type of dizziness—vertigo—occurs. The inner ear is very sensitive to minor alterations of blood flow and all of the causes mentioned for poor circulation to the brain also apply specifically to the inner ear.
Neurological diseases: A number of diseases of the nerves can affect balance, such as multiple sclerosis, syphilis, tumors, etc. These are uncommon causes, but your doctor may perform certain tests to evaluate these.
Anxiety: Anxiety can be a cause of dizziness and lightheadedness. Unconscious overbreathing (hyperventilation) can be experienced as overt panic, or just mild dizziness with tingling in the hands, feet, or face. Instruction on correct breathing technique may be required.
Vertigo: An unpleasant sensation of the world rotating, usually associated with nausea and vomiting. Vertigo usually is due to an issue with the inner ear. The common causes of vertigo are (in order):
- Benign Positional Vertigo: Vertigo is experienced after a change in head position such as lying down, turning in bed, looking up, or stooping. It lasts about 30 seconds and ceases when the head is still. It is due to a dislodged otololith crystal entering one of the semicircular balance canals. It can last for days, weeks, or months. The Epley “repositioning” treatment by an otolaryngologist is usually curative. BPV is the commonest cause of dizziness after (even a mild) head injury.
- Meniere’s disease: An inner ear disorder with attacks of vertigo (lasting hours), nausea, or vomiting, and tinnitus (loud noise) in the ear, which often feels blocked or full. There is usually a decrease in hearing as well.
- Migraine: Some individuals with a prior classical migraine headache history can experience vertigo attacks similar to Meniere’s disease. Usually there is an accompanying headache, but can also occur without the headache.
- Infection: Viruses can attack the inner ear, but usually its nerve connections to the brain, causing acute vertigo (lasting days) without hearing loss (termed vestibular neuronitis). However, a bacterial infection such as mastoiditis that extends into the inner ear can completely destroy both the hearing and equilibrium function of that ear, called labyrinthitis.
- Injury: A skull fracture that damages the inner ear produces a profound and incapacitating vertigo with nausea and hearing loss. The dizziness will last for several weeks and slowly improve as the other (normal) side takes over. BPV commonly occurs after head injury.
- Allergy: Some people experience dizziness and/or vertigo attacks when they are exposed to foods or airborne particles (such as dust, molds, pollens, dander, etc.) to which they are allergic.
When should I seek medical attention?
Call 911 or go to an emergency room if you experience:
- Dizziness after a head injury,
- fever over 101°F, headache, or very stiff neck,
- convulsions or ongoing vomiting,
- chest pain, heart palpitations, shortness of breath, weakness, a severe headache, inability to move an arm or leg, change in vision or speech, or
- fainting and/or loss of consciousness
Consult your doctor if you:
- have never experienced dizziness before,
- experience a difference in symptoms you have had in the past,
- suspect that medication is causing your symptoms, or
- experience hearing loss.
How will my dizziness be treated?
The doctor will ask you to describe your dizziness and answer questions about your general health. Along with these questions, your doctor will examine your ears, nose, and throat. Some routine tests will be performed to check your blood pressure, nerve and balance function, and hearing. Possible additional tests may include a CT or MRI scan of your head, special tests of eye motion after warm or cold water or air is used to stimulate the inner ear (ENG—electronystagmography or VNG—videonystagmography), and in some cases, blood tests or a cardiology (heart) evaluation. Balance testing may also include rotational chair testing and posturography. Your doctor will determine the best treatment based on your symptoms and the cause of them. Treatments may include medications and balance exercises.
- Avoid rapid changes in position
- Avoid rapid head motion (especially turning or twisting)
- Eliminate or decrease use of products that impair circulation, e.g., tobacco, alcohol, caffeine, and salt
- Minimize stress and avoid substances to which you are allergic
- Get enough fluids
- Treat infections, including ear infections, colds, flu, sinus congestion, and other respiratory infections
If you are subject to motion sickness:
- Do not read while traveling
- Avoid sitting in the rear seat
- Do not sit in a seat facing backward
- Do not watch or talk to another traveler who is having motion sickness
- Avoid strong odors and spicy or greasy foods immediately before and during your travel
- Talk to your doctor about medications
Remember: Most cases of dizziness and motion sickness are mild and self-treatable. But severe cases and those that become progressively worse deserve the attention of a doctor with specialized skills in diseases of the ear, nose, throat, equilibrium, and neurological systems.
Playing catch, shooting hoops, bicycling on a scenic path or just kicking around a soccer ball have more in common than you may think. On the up side, these activities are good exercise and are enjoyed by thousands of Americans. On the down side, they can result in a variety of injuries to the face.
Many injuries are preventable by wearing the proper protective gear, and your attitude toward safety can make a big difference. However, even the most careful person can get hurt. When an accident happens, it’s your response that can make the difference between a temporary inconvenience and permanent injury.
When Someone Gets Hurt:
What First Aid Supplies Should You Have on Hand in Case of An Emergency?
- Sterile cloth or pads
- Ice pack
- Sterile bandages
- Cotton tipped swabs
- Hydrogen peroxide
- Nose drops
- Antibiotic ointment
- Eye pads
- Cotton balls
- Butterfly bandages
Ask “Are you all right?” Determine whether the injured person is breathing and knows who and where they are.
Be certain the person can see, hear and maintain balance. Watch for subtle changes in behavior or speech, such as slurring or stuttering. Any abnormal response requires medical attention.
Note weakness or loss of movement in the forehead, eyelids, cheeks and mouth.
Look at the eyes to make sure they move in the same direction and that both pupils are the same size.
If any doubts exist, seek immediate medical attention.
When Medical Attention Is Required, What Can You Do?
- Call for medical assistance (911).
- Do not move the victim, or remove helmets or protective gear.
- Do not give food, drink or medication until the extent of the injury has been determined.
- Remember HIV…be very careful around body fluids. In an emergency protect your hands with plastic bags.
- Apply pressure to bleeding wounds with a clean cloth or pad, unless the eye or eyelid is affected or a loose bone can be felt in a head injury. In these cases, do not apply pressure but gently cover the wound with a clean cloth.
- Apply ice or a cold pack to areas that have suffered a blow (such as a bump on the head) to help control swelling and pain.
- Remember to advise your doctor if the patient has HIV or hepatitis.
Sports injuries can cause potentially serious broken bones or fractures of the face. Common symptoms of facial fractures include:
- Swelling and bruising, such as a black eye
- Pain or numbness in the face, cheeks or lips
- Double or blurred vision
- Changes in teeth structure or ability to close mouth properly
It is important to pay attention to swelling because it may be masking a more serious injury. Applying ice packs and keeping the head elevated may reduce early swelling.
If any of these symptoms occur, be sure to visit the emergency room or the office of a facial plastic surgeon (such as an otolaryngologist-head and neck surgeon) where x-rays may be taken to determine if there is a fracture.
When you are hit in the upper face (by a ball for example) it can fracture the delicate bones around the sinuses, eye sockets, bridge of the nose or cheek bones. A direct blow to the eye may cause a fracture, as well as blurred or double vision. All eye injuries should be examined by an eye specialist (ophthalmologist).
When your jaw or lower face is injured, it may change the way your teeth fit together. To restore a normal bite, surgeries often can be performed from inside the mouth to prevent visible scarring of the face; and broken jaws often can be repaired without being wired shut for long periods. Your doctor will explain your treatment options and the latest treatment techniques.
Soft Tissue Injuries
Bruises cuts and scrapes often result from high speed or contact sports, such as boxing, football, soccer, ice hockey, bicycling skiing, and snowmobiling. Most can be treated at home, but some require medical attention.
You should get immediate medical care when you have:
- Deep skin cuts
- Obvious deformity or fracture
- Loss of facial movement
- Persistent bleeding
- Change in vision
- Problems breathing and/or swallowing
- Alterations in consciousness or facial movement
Also called contusions, bruises result from bleeding underneath the skin. Applying pressure, elevating the bruised area above the heart and using an ice pack for the first 24 to 48 hours minimizes discoloration and swelling. After two days, a heat pack or hot water bottle may help more. Most of the swelling and bruising should disappear in one to two weeks.
Cuts and Scrapes
The external bleeding that results from cuts and scrapes can be stopped by immediately applying pressure with gauze or a clean cloth. When the bleeding is uncontrollable, you should go to the emergency room.
Scrapes should be washed with soap and water to remove any foreign material that could cause infection and discoloration of the skin. Scrapes or abrasions can be treated at home by cleaning with 3% hydrogen peroxide and covering with an antibiotic ointment or cream until the skin is healed. Cuts or lacerations, unless very small, should be examined by a physician. Stitches may be necessary, and deeper cuts may have serious effects. Following stitches, cuts should be kept clean and free of scabs with hydrogen peroxide and antibiotic ointment. Bandages may be needed to protect the area from pressure or irritation from clothes. You may experience numbness around the cut for several months. Healing will continue for 6 to 12 months. The application of sunscreen is important during the healing process to prevent pigment changes. Scars that look too obvious after this time should be seen by a facial plastic surgeon.
The nose is one of the most injured areas on the face. Early treatment of a nose injury consists of applying a cold compress and keeping the head higher than the rest of the body. You should seek medical attention in the case of:
- Breathing difficulties
- Deformity of the nose
- Persistent bleeding
Nosebleeds are common and usually short-lived. Often they can be controlled by squeezing the nose with constant pressure for 5 to 10 minutes. If bleeding persists, seek medical attention.
Bleeding also can occur underneath the surface of the nose. An otolaryngologist/facial plastic surgeon will examine the nose to determine if there is a clot or collection of blood beneath the mucus membrane of the septum (a septal hematoma) or any fracture. Hematomas should be drained so the pressure does not cause nose damage or infection.
Some otolaryngologist-head and neck specialists set fractured bones right away before swelling develops, while others prefer to wait until the swelling is gone. These fractures can be repaired under local or general anesthesia, even weeks later.
Ultimately, treatment decisions will be made to restore proper function of the nasal air passages and normal appearance and structural support of the nose. Swelling and bruising of the nose may last for 10 days or more.
Whether seemingly minor or severe, all neck injuries should be thoroughly evaluated by an otolaryngologist — head and neck surgeon. Injuries may involve specific structures within the neck, such as the larynx (voicebox), esophagus (food passage), or major blood vessels and nerves.
The larynx is a complex organ consisting of cartilage, nerves and muscles with a mucous membrane lining all encased in a protective tissue (cartilage) framework.
The cartilages can be fractured or dislocated and may cause severe swelling, which can result in airway obstruction. Hoarseness or difficulty breathing after a blow to the neck are warning signs of a serious injury and the injured person should receive immediate medical attention.
Prevention Of Facial Sports Injuries
The best way to treat facial sports injuries is to prevent them. To insure a safe athletic environment, the following guidelines are suggested:
- Be sure the playing areas are large enough that players will not run into walls or other obstructions.
- Cover unremoveable goal posts and other structures with thick, protective padding.
- Carefully check equipment to be sure it is functioning properly.
- Require protective equipment – such as helmets and padding for football, bicycling and rollerblading; face masks, head and mouth guards for baseball; ear protectors for wrestlers; and eyeglass guards or goggles for racquetball and snowmobiling are just a few.
- Prepare athletes with warm-up exercises before engaging in intense team activity.
- In the case of sports involving fast-moving vehicles, for example, snowmobiles or dirt bikes – check the path of travel, making sure there are no obstructing fences, wires or other obstacles.
- Enlist adequate adult supervision for all children’s competitive sports.
What is facial trauma?
The term facial trauma means any injury to the face or upper jaw bone. Facial traumas include injuries to the skin, underlying skeleton, neck, nose and sinuses, eye socket, or teeth and other parts of the mouth. Sometimes these types of injuries are called maxillofacial injury. Facial trauma is often recognized by swelling or lacerations (breaks in the skin). Signs of broken bones include bruising around the eyes, widening of the distance between the eyes, movement of the upper jaw when the head is stabilized, abnormal sensations on the face, and bleeding from the nose, mouth, or ear.
In the U.S., about three million people are treated in emergency departments for facial trauma injuries each year. Of the pediatric patients, 5 percent have suffered facial fractures. In children under three years old, the primary cause of these fractures is falls. In children more than five years old, the primary cause for facial trauma is motor vehicle accidents. Fortunately, the correct use of seat belts, boosters, and car seats can dramatically reduce the risk of facial trauma in children.
A number of activities put children at risk for facial injury, such as contact sports, cheerleading, gymnastics, and cycling. Proper supervision and appropriate protective gear should always be employed during these activities. But when accidents do happen, children’s facial injuries require special attention, as a child’s future growth plays a big role in treatment for facial trauma. So one of the most important issues for a caregiver is to follow a physician’s treatment plan as closely as possible until your child is fully recovered.
Why is facial trauma different in children than adults?
Facial trauma can range between minor injury to disfigurement that lasts a lifetime. The face is critical in communicating with others, so it is important to get the best treatment possible. Pediatric facial trauma differs from adult injury because the face is not fully formed and future growth will be a factor in how the child heals and recovers. Certain types of trauma may cause a delay in growth or further complicate recovery. Difficult cases require doctors or a team of doctors with special skills to make a repair that will grow with your child.
Types of facial trauma
New technology, such as advanced CT scans that can provide three-dimensional anatomic detail, has improved physicians’ ability to evaluate and manage facial trauma. In some cases, immediate surgery is needed to realign fractures before they heal incorrectly. Other injuries will have better outcomes if repairs are done after cuts and swelling have improved. Research has shown that even when an injury does not require surgery, it is important to a child’s health and welfare to continue to follow up with a physician’s care.
Soft tissue injuries
Injuries such as cuts (lacerations) may occur on the soft tissue of the face. In combination with suturing the wound, the provider should take care to inspect and treat any injures to the facial nerves, glands, or ducts. In younger children, many lacerations require sedation or general anesthesia to achieve the best repair.
When facial bone fractures occur, the treatment is similar to that of a fracture in other parts of the body. Some injuries may not need treatment, and others may require stabilization and fixation using wires, plates, and screws. Factors influencing these treatment decisions are the location of the fracture, the severity of the fracture, and the age and general health of the patient. It is important during treatment of facial fractures to be careful that the patient’s facial appearance is minimally affected.
Injuries to the teeth and surrounding dental structures style
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Because of the specific needs of the dental structures, certain actions and precautions should be taken if a child has received an injury to his or her teeth or surrounding dental structures.
- If a tooth is “knocked out” it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better the chance it will survive, so the patient should see a dentist or oral surgeon as soon as possible.
- Never attempt to “wipe the tooth off” since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth.
Stewart MG, Chen AY. Factors predictive of poor compliance with follow-up after Facial trauma: A prospective study. Otolaryngol Head Neck Surg 1997: 117:72-75
Kim MK, Buchman R, Szeremeta. Penetrating neck trauma in children: An urban hospital’s experience. Otolaryngol Head Neck Surg 2000: 123: 439-43
What is cleft lip and cleft palate?
We all start out life with a cleft lip and palate. During normal fetal development between the 6th and 11th week of pregnancy, the clefts in the lip and palate fuse together. In babies born with cleft lip or cleft palate, one or both of these splits failed to fuse.
A “cleft” means a split or separation; the palate is the “roof” of the mouth. A cleft palate or lip then is a split in the oral (mouth) structure. Physicians call clefting a “craniofacial anomaly.” A child can be born with both a cleft lip and cleft palate or a cleft in just one area. Oral clefts are one of the most common birth defects.
Clefts in the lip can range from a tiny notch in the upper lip to a split that extends into the nose. A cleft palate can range from a small malformation that results in minimal problems to a large separation of the palate that interferes with eating, speaking, and even breathing. Clefts are often referred to as unilateral, a split on one side, or bilateral, one split on each side. There are three primary types of clefts:
- Cleft lip/palate refers to the condition when both the palate and lip are cleft. About one in 1,000 babies are born with cleft lip/palate.
- About 50 percent of all clefts
- More common in Asians and certain groups of American Indians
- Occurs less frequently in African Americans
- Up to 13 percent of cases present with other birth defects
- Occurs more often in male children
- Isolated cleft palate is the term used when a cleft occurs only in the palate. About one in 2,000 babies are born with this type of cleft (the incidence of submucous cleft palate, a type of isolated cleft palate, is one in 1,200).
- About 30 percent of all clefts
- All racial groups have similar risk
- Occurs more often in female children
- Isolated cleft lip refers to a cleft in the lip only accounting for 20 percent of all clefts.
What causes clefts?
No one knows exactly what causes clefts, but most believe they are caused by one or more of three main factors: an inherited characteristic (gene) from one or both parents, environment (poor early pregnancy health or exposure to toxins such as alcohol or cocaine), and genetic syndromes. A syndrome is an abnormality in genes on chromosomes that result in malformations or deformities that form a recognizable pattern. Cleft lip/palate is a part of more than 400 syndromes including Waardenburg, Pierre Robin, and Down syndromes. Approximately 30 percent of cleft deformities are associated with a syndrome, so a thorough medical evaluation and genetic counseling is recommended for cleft patients.
How is a cleft diagnosed?
Clefting of the lip and palate is usually visible during the baby’s first examination. One exception is a submucous cleft where the palate is cleft, but remains covered by smooth, unbroken lining of the mouth. A child with cleft lip or palate is often referred to a multidisciplinary team of experts for treatment. The team may include: an otolaryngologist (ear, nose, and throat specialist), plastic surgeon, oral surgeon, speech pathologist, pediatric dentist, orthodontist, audiologist, geneticist, pediatrician, nutritionist, and psychologist/social worker.
How are clefts treated?
Treatment of clefts is highly individual, depending on the overall health of the child and the severity and location of the cleft(s). Multiple surgeries and long-term follow-up are often necessary. Because clefts can interfere with physical, language and psychological development, treatment is recommended as early as possible. Surgery to repair a cleft lip is usually done between 10 and 12 weeks of age. A cleft palate is repaired through a procedure called palatoplasy, which is done between nine and 18 months. Additional surgeries are often needed to achieve the best results. In addition to surgery, the child may receive follow-up care from members of the multidisciplinary team on issues of speech, hearing, growth, dental, and psychological development.
What are the complications of clefts?
The complications of cleft lip and cleft palate can vary greatly depending on the degree and location of the cleft. They can include all or some or all of the following:
Breathing: When the palate and jaw are malformed, breathing becomes difficult. Treatments include surgery and oral appliances.
Feeding: Problems with feeding are more common in cleft children. A nutritionist and speech therapist that specializes in swallowing may be helpful. Special feeding devices are also available.
Ear infections and hearing loss: Any malformation of the upper airway can affect the function of the Eustachian tube and increase the possibility of persistent fluid in the middle ear, which is a primary cause of repeat ear infections. Hearing loss can be a consequence of repeat ear infections and persistent middle ear fluid. Tubes can be inserted in the ear by an otolaryngologist to alleviate fluid build-up and restore hearing.
Speech and language delays: Normal development of the lips and palate are essential for a child to properly form sounds and speak clearly. Cleft surgery repairs these structures; speech therapy helps with language development.
Dental problems: Sometimes a cleft involves the gums and jaw, affecting the proper growth of teeth and alignment of the jaw. A pediatric dentist or orthodontist can assist with this problem.
Tumors or growths in the head and neck region may be divided into those that are benign (not cancerous) and malignant (i.e., cancer). Fortunately, most growths in the head and neck region in children are considered to be benign. These benign growths can be related to infection, inflammation, fluid collections, swellings, or neoplasms (tumors) that are non life-threatening. The malignant growths, on the other hand, may be life-threatening and cause other problems related to their growth and spread. Even the malignant growths in the head and neck are usually treatable.
It is very common for children to have enlarged tonsils and adenoids. These are almost always from an infection or inflammation. It is very rare that children develop a cancer, lymphoma, or sarcoma of these areas. When the tonsils, adenoids, or other areas of the mouth or throat remain enlarged or are enlarged on only one side, it is important to have an evaluation by a specialist in ear, nose and throat or otolaryngology-head and neck surgery.
The lymph nodes of the neck region may become enlarged during childhood. Most of the time, this is reactive in nature and related to inflammation or infection. However, if the lymph nodes remain enlarged for a period of time without going away, it is important to have an otolaryngologist-head and neck surgeon evaluate the problem.
Other benign growths in the face and neck include cysts (fluid collection) such as branchial cleft cyst, thyroglossal duct cyst, cystic hygroma, and dermoid cysts. These often require removal due to their continued growth and potential for infection. Growths of blood vessels often are seen in the face and neck and these are often referred to as hemangiomas, vascular malformations, lymphatic and arteriovenous malformations (AVM). Some of these may require removal or treatment depending upon the type and location.
Sinus and Nose Growths
Although most children have nose bleeds and occasional allergies and sinus infection, sometimes tumors of the nose and sinus present with similar symptoms. It is generally recommended that a child with continuous sinus problems or nose bleeds be evaluated by an otolaryngologist-head and neck surgeon to be sure it is not a tumor or other treatable condition.
Non-epithelial neoplasms constitute the majority of sinonasal (sinus) tumors in children and adolescents. Among these, rhabdomyosarcoma (RMS) or undifferentiated sarcoma and non-Hodgkin lymphoma account for the majority of cases. Among head and neck RMS 14 percent arise from the nasal cavity and 10 percent from the paranasal sinuses. Nasopharyngeal carcinoma accounts for one third of the nasopharyngeal neoplasms in children. As is the case in adult patients, it is associated with Epstein-Barr virus (EBV) infection as demonstrated by EBV DNA presence in malignant cells. Less frequently, Ewing’s sarcoma/PNET can present in this location. These tumors have also been described as secondary malignancies following treatment of retinoblastoma and other neoplasms. Esthesioneuroblastoma is a rare sinonasal tumor historically related to Ewing/PNET, although more recently comparative genomic hybridization analysis disputes this relation. Other less common sinonasal tumors presenting in children include hemangioma and hemagiopericitoma, fibroma and fibrosarcoma, malignant fibrous histiocytoma, and desmoid fibromatosis.
Salivary Gland Tumors
There are three paired sets of salivary glands in the head and neck region. These include the ones in front of the ears (parotid), below the jaw (submandibular), and underneath the tongue (sublingual). Additionally, there are numerous very small salivary glands throughout the mouth and throat. Although tumors can arise in these areas, they are rare. Thus, any child with a growth in these areas should be seen by an otolaryngologist-head and neck surgeon.
The thyroid gland is found in the front of the lower part of the neck just above the chest area but below the Adam’s apple on both sides. Although tumors can arise in this area, they are rare. Thus, any child with a growth in this area should be seen by an otolaryngologist-head and neck surgeon.
Can Over-the-Counter Medications Help?
Why Do We Suffer From Nasal And Sinus Discomfort?
The body’s nasal and sinus membranes have similar responses to viruses, allergic insults, and common bacterial infections. Membranes become swollen and congested. This congestion causes pain and pressure; mucus production increases during inflammation, resulting in a drippy, runny nose. These secretions may thicken over time, may slow in their drainage, and may predispose to future bacterial infection of the sinuses.
Congestion of the nasal membranes may even block the eustachian tube leading to the ear, resulting in a feeling of blockage in the ear or fluid behind the eardrum. Additionally, nasal airway congestion causes the individual to breathe through the mouth.
Each year, more than 37 million Americans suffer from sinusitis, which typically includes nasal congestion, thick yellow-green nasal discharge, facial pain, and pressure. Many do not understand the nature of their illness or what produces their symptoms. Consequently, before visiting a physician, they seek relief for their nasal and sinus discomfort by taking non-prescription or over-the-counter (OTC) medications.
What Is The Role Of OTC Medication For Sinus Pain?
There are many different OTC medications available to relieve the common complaints of sinus pain and pressure, allergy problems, and nasal congestion. Most of these medications are combination products that associate either a pain reliever such as acetaminophen with a decongestant or an antihistamine. Knowledge of these products and of the probable cause of symptoms will help the consumer to decide which product is best suited to relieve the common symptoms associated with nasal or sinus inflammation.
OTC nasal medications are designed to reduce symptoms produced by the inflammation of nasal membranes and sinuses. The goals of OTC medications are to: (1) reopen to nasal passages; (2) reduce nasal congestion; (3) relieve pain and pressure symptoms; and (4) reduce potential for complications. The medications come in several forms.
Nasal Saline Sprays: Non-Medicated Nasal Sprays
Nasal saline is an invaluable addition to the list of over-the-counter medications. It is ideal for all types of nasal problems. The added moisture produced by the saline reduces thick secretions and assists in the removal of infectious agents. There is no risk of becoming “addicted” to nasal saline. It should be applied as a mist to the nose up to six times per day. Nasal saline can also be made at home: contact your otolaryngologist for details.
Nasal Decongestant Sprays: Medicated Nasal Sprays
Afrin nasal spray, Neo-Synephrine, Otrivin, Dristan nasal spray, and other brands decongest the swollen nasal membranes. They clear nasal passages almost immediately and are useful in treating the initial stages of a common cold or viral infection. Nasal decongestant sprays are safe to use, especially appropriate for preventing eustachian tube problems when flying, and to halt progression of sinus infections following colds. However, they should only be utilized for 3-5 days because prolonged use leads to rebound congestion or “getting hooked on nasal sprays.” The patient with nasal swelling caused by seasonal allergy problems should use a cromolyn sodium nasal spray. The spray must be used frequently (four times a day) during allergy season to prevent the release of histamine from the tissues, which starts the allergic reaction. It works best before symptoms become established by stabilizing the nasal membranes and has few side effects.
Pressure and congestion are common symptoms of nasal passage swelling. Decongestant medications are OTC products that relieve nasal swelling, pressure, and congestion but do not treat the cause of the inflammation. They reduce blood flow to the nasal membranes leading to improved airflow, less breathing through the mouth, decreased pressure in the sinuses and head, and subsequently less discomfort. Decongestants do not relieve drippy noses. Their side effects may include light headedness or giddiness and increased blood pressure and heart rate. (Patients with high blood pressure or heart problems should consult a physician before use.) In addition, other medications may interact with oral decongestants causing side effects. Both of these are available as single products or in combination with a pain reliever or an antihistamine. They are labeled as “non-drowsy” due to a side effect of stimulation of the nervous system.
Some medications are combined to reduce the number of pills. TylenolÂ® Sinus or Advil Cold and SinusÂ® exemplify products that join a pain reliever (acetaminophen or ibuprophen) with a decongestant (pseudoephedrine). These products relieve both sinus and cold/flu symptoms yet retain all the attributes of the individual drug including side effects.
Antihistamines combat allergic problems leading to nasal congestion. OTC antihistamines such as diphenhydramine (BenadrylÂ®), or clemastine (TavistÂ®) may be used for relieving allergic symptoms of itching, sneezing, and nasal congestion. They relieve the drainage associated with the allergic inflammation but not obstruction or congestion. Antihistamines have a potential for sedation causing grogginess and dryness after use. Newer nonsedating antihistamines are available.
Antihistamine-Decongestant Combination Products
Antihistamines and decongestant products are often combined to relieve multiple symptoms of congestion and drainage and reduce the side effects of both products. Antihistamines produce sedation; decongestants are added to make them “non-drowsy.” The combined allergy product then relieves congestion and a runny nose.
Insight into preventing injuries caused by falls
- Why are falls more likely during the senior years?
- How does lifestyle management affect fall prevention?
- and more…
Today’s society is more active than ever, but inevitably every year more than two million Americans fall and sustain serious injury, costing the healthcare system in excess of $3 billion dollars. Hidden costs affecting the individual include pain, disability, lawsuits, loss of independence, deterioration in well-being, and the impact on other family members. Nonetheless, falls are predictable and preventable, even for older adults.
Why are falls more likely during the senior years?
Falls and the resulting injuries are among the most serious health issues affecting the elderly population. The increased risk for falls in the elderly can be attributed, in general, to the body’s deterioration due to inactivity and a slow deterioration of the central nervous system (CNS). For example, the sensory cells in the ears’ balance system gradually decrease in number and cannot be replaced. The nerves that carry sensory information to the brain lose fiber and nerve cells, leading to problems with the function of complex brain interconnections. In addition, nerve endings lose their ability to produce the chemicals responsible for the transmission of information. This process accelerates after age 50.
Many systemic diseases can affect the CNS and sense organs and therefore increase the likelihood of instability and the risk of falling. In addition, muscle strength gradually decreases with age and joint tendons and ligaments lose their flexibility, resulting in limited range of motion. The combined effects of bone and joint disease and inactivity can result in a body that can no longer carry out complex motion commands initiated by the brain. Atherosclerotic cardiovascular disease (hardening of the arteries) is another disease process that can affect balance. It is accelerated by high blood pressure, smoking, and diabetes. Although artery hardening gradually increases during middle age, there is a point at which a slight additional decrease in blood flow causes serious vascular impairment, such as stroke.
Head injuries, sometimes caused by falls, can damage the sense organs in the inner ears, or the brain itself. Therefore, physical activity is very important for injury recovery to the sensory systems. The general debility of aging can negatively affect recovery if it results in a decreased level of activity. Often, injuries to the knees, hips, and back do not completely heal, leaving some limitation of motion.
Arthritis can cause permanent crippling, nonreversible, effects on the bones and joints of the hips, knees, and ankles, and osteoporosis can lead to bone weakness. Together, these ailments can dramatically increase the probability of serious injury from a fall or cause a spontaneous fracture that might lead to a fall.
How can medications affect my sensory functions?
In this time of specialization, it is possible for a patient to receive from several physicians prescriptions that might have additive side effects on the brain and sensory function. Therefore, patients should keep a complete list of all their medications and dosages, and make this list available to each physician they consult. Coordination of all medications through a single primary care physician would help avoid adverse drug reactions to the brain and sensory functions. The list should include:
- Over-the-counter medications, such as antihistamines, sleeping medications, analgesics, and cough suppressants.
- Medications used to treat high blood pressure, heart disease, allergy, insomnia, stomach acidity, and depression.
- Medications listing alcohol as an ingredient, since it affects movement and judgment and adversely interacts with many medications.
How can I recover from an injury caused by a fall?
- A thorough and complete evaluation of sensory, CNS, muscle/joint, and balance functions should be performed. This includes a search for causes of dizziness, such as inner ear diseases; an evaluation of the inner ear balance system, which might be adversely affected by certain drugs (such as a class of antibiotics known as aminoglycocides); trauma; and the aging process.
- Tests of higher mental function are important, since falling can be a sign of serious mental deterioration.
- A careful review of all medications (both prescription and over-the-counter) is very important. If medication for anxiety or depression is used, switching from a long-acting drug to one that is more quickly passed from the body seems to decrease the risk of falling.
All correctable problems should be treated. That includes visual correction with proper eyeglasses, improvement of hearing by hearing aids, adjustment or elimination of medications, and treatment of any other disease which could impair balance.
Rehabilitation includes increasing the range of motion, as well as physical strength. A very important part of rehabilitation is overcoming the fear of falling, thus avoiding further injury. Walkers and canes can aid stability, while simple changes in the home, such as installing hand-holds in bathrooms or along walls, could decrease the likelihood of falling and increase confidence. But keep in mind, drastically changing a familiar environment often hampers recovery. As soon as possible, rehabilitation should include family members and home support groups. Rapid return to physical activity and social interaction with family and community can often stop the vicious spiral into inactivity, reclusiveness, and progressive deterioration that falls and injuries cause.
How does lifestyle management affect fall prevention?
As many of the problems responsible for falling develop during early and middle age, initial efforts to prevent injuries should begin at a younger age. Many of the changes in muscle, bone, and the central nervous system are not inevitable results of aging, but are brought on by inactive lifestyles and self-inflicted damage from smoking, poor diet, and lack of exercise. Although hardening of the arteries is occasionally hereditary, in most cases it can be reduced by diets low in cholesterol and saturated fatty acids, as well as regular physical exercise.
Tips to prevent falls among seniors
- Have hearing and vision check-ups regularly. If hearing and vision are impaired, important cues that help maintain balance can be lost.
- Get up slowly. A momentary drop in blood pressure can cause dizziness when standing up too quickly.
- Use a cane or walker to help maintain balance on uneven ground or slippery surfaces. Wear sturdy, low-heeled shoes with wide, nonslip soles.
- Exercise to improve your strength, muscle tone, and coordination. Walking is a good form of exercise.
- Remove raised doorway thresholds in all rooms. Rearrange furniture to keep electrical cords and furniture out of walking paths. Fasten area rugs to the floor with tape or tacks.
- Never stand on a chair. Use nonskid floor wax and wipe up spills immediately.
- Be sure stairways have sturdy hand rails.
- Install grab handles and nonskid mats inside and outside your shower and tub.
- Use shower chairs and bath benches to minimize the risk of falling.
Put a light switch by the bedroom door and by your bed so you don’t have to walk across the room to turn on a light. Night lights in your bedrooms, halls, and bathroom are a good idea.
Insight into recognizing symptoms for early detection
- Early detection of head and neck cancer
- Symptoms of head and neck cancer
- and more…
This year, more than 55,000 Americans will develop cancer of the head and neck (most of which is preventable); nearly 13,000 of them will die from it.
Early detection of head and neck cancer
Tobacco use is the most preventable cause of these deaths. In the United States, up to 200,000 people die each year from smoking-related illnesses. The good news is that this figure has decreased due to the increasing number of Americans who have quit smoking. The bad news is that some of these smokers switched to smokeless or spit tobacco, assuming it is a safe alternative. This is untrue. By doing so, they are only changing the site of the cancer risk from their lungs to their mouths. While lung cancer cases are decreasing, cancers in the head and neck appear to be increasing, but they are curable if caught early. Fortunately, most head and neck cancers produce early symptoms. You should know the potential warning signs so you can alert your doctor as soon as possible. Remember—successful treatment of head and neck cancer depends on early detection. Knowing and recognizing its signs can save your life.
Symptoms of head and neck cancer
A lump in the neck. Cancers that begin in the head or neck usually spread to lymph nodes in the neck before they spread elsewhere. A lump in the neck that lasts more than two weeks should be seen by a physician as soon as possible. Of course, not all lumps are cancer. But a lump (or lumps) in the neck can be the first sign of cancer of the mouth, throat, voicebox (larynx), thyroid gland, or of certain lymphomas and blood cancers. Such lumps are generally painless and continue to enlarge steadily.
Change in the voice. Most cancers in the larynx cause some changes in voice. An otolaryngologist is a head and neck specialist who can examine your vocal cords easily and painlessly. While most voice changes are not caused by cancer, you shouldn’t take chances. If you are hoarse or notice voice changes for more than two weeks, see your doctor.
A growth in the mouth. Most cancers of the mouth or tongue cause a sore or swelling that doesn’t go away. These may be painless, which can be misleading. Bleeding may occur, but often not until late in the disease. If an ulcer or swelling is accompanied by lumps in the neck, you should be concerned. In addition, any sore or swelling in the mouth that does not go away after a week should be evaluated by a physician. Your dentist or doctor can determine if a biopsy (tissue sample test) is needed and can refer you to a head and neck surgeon who can perform this procedure.
Bringing up blood. This is often caused by something other than cancer. However, tumors in the nose, mouth, throat, or lungs can cause bleeding. If blood appears in your saliva or phlegm for more than a few days, you should see your physician.
Swallowing problems. Cancer of the throat or esophagus (swallowing tube) may make swallowing solid foods—and sometimes liquids—difficult. The food may “stick” at a certain point and then either go through to the stomach or come back up. If you have trouble almost every time you try to swallow something, you should be examined by a physician. Usually a barium swallow x-ray or an esophagoscopy (direct examination of the swallowing tube with a scope) will be performed to find the cause.
Changes in the skin. The most common head and neck cancer is basal cell cancer of the skin. Fortunately, this is rarely serious if treated early. Basal cell cancers appear most often on sun-exposed areas like the forehead, face, and ears, but can occur almost anywhere on the skin. Basal cell cancer often begins as a small, pale patch that enlarges slowly, producing a central “dimple” and eventually an ulcer. Parts of the ulcer may heal, but the major portion remains ulcerated. Some basal cell cancers show color changes. Other kinds of cancer, including squamous cell cancer and malignant melanoma, also occur on the head and neck. Most squamous cell cancers occur on the lower lip and ear. They may look like basal cell cancers, and if caught early and properly treated, usually are not dangerous. If there is a sore on the lip, lower face, or ear that does not heal, consult a physician. Malignant melanoma typically produces a blue-black or black discoloration of the skin. However, any mole that changes size, color, or begins to bleed may mean trouble. A black or blue-black spot on the face or neck, particularly if it changes size or shape, should be seen as soon as possible by a dermatologist or other physician.
Persistent earache. Constant pain in or around the ear when you swallow can be a sign of infection or tumor growth in the throat. This is particularly serious if it is associated with difficulty in swallowing, hoarseness, or a lump in the neck. These symptoms should be evaluated by an otolaryngologist.
Identifying high risk of head and neck cancer
As many as 90 percent of head and neck cancers arise after prolonged exposure to specific risk factors. Use of tobacco (cigarettes, cigars, chewing tobacco, or snuff) and alcoholic beverages are the most common cause of cancers of the mouth, throat, voice box, and tongue. In adults who do not smoke or drink, cancer of the throat can occur as a result of infection with the human papilloma virus (HPV). Prolonged exposure to sunlight is linked with cancer of the lip and is also established as a major cause of skin cancer.
What you should do. All of the symptoms and signs described here can occur with no cancer present. In fact, many times complaints of this type are due to some other condition. But you can’t tell without an examination. So if they do occur, see your doctor to be sure.
Remember—when found early, most cancers in the head and neck can be cured with few side effects. Cure rates for these cancers could be greatly improved if people would seek medical advice as soon as possible. Play it safe. If you detect warning signs of head and neck cancer, see your doctor immediately. And practice health habits which help prevent these diseases.
Not every headache is the consequence of sinus and nasal passage problems. For example, many patients visit an ear, nose, and throat specialist to seek treatment for a sinus headache and learn they actually have a migraine or tension headache. The confusion is common, a migraine can cause irritation of the trigeminal or fifth cranial nerve (with branches in the forehead, cheeks and jaw). This may produce pain at the lower-end branches of the nerve, in or near the sinus cavity.
Symptoms Of Sinusitis
Pain in the sinus area does not automatically mean that you have a sinus disorder. On the other hand, sinus and nasal passages can become inflamed leading to a headache. Headache is one of the key symptoms of patients diagnosed with acute or chronic sinusitis. In addition to a headache, sinusitis patients often complain of:
- Pain and pressure around the eyes, across the cheeks and the forehead
- Achy feeling in the upper teeth
- Fever and chills
- Facial swelling
- Nasal stuffiness
- Yellow or green discharge
However, it is important to note that there are some cases of headaches related to chronic sinusitis without other upper respiratory symptoms. This suggests that an examination for sinusitis be considered when treatment for a migraine or other headache disorder is unsuccessful.
Treatment For A Sinus Headache
Sinus headaches are associated with a swelling of the membranes lining the sinuses (spaces adjacent to the nasal passages). Pain occurs in the affected region – the result of air, pus, and mucus being trapped within the obstructed sinuses. The discomfort often occurs under the eye and in the upper teeth (disguised as a headache or toothache). Sinus headaches tend to worsen as you bend forward or lie down. The key to relieving the symptoms is to reduce sinus swelling and inflammation and facilitate mucous drainage from the sinuses.
There are several at-home steps that help prevent sinus headache or alleviate its pain. They include:
Breathe moist air: Relief for a sinus headache can be achieved by humidifying the dry air environment. This can be done by using a steam vaporizer or cool-mist humidifier, steam from a basin of hot water, or steam from a hot shower.
Alternate hot and cold compresses: Place a hot compress across your sinuses for three minutes, and then a cold compress for 30 seconds. Repeat this procedure three times per treatment, two to six times a day.
Nasal irrigation: Some believe that when nasal irrigation or rinse is performed, mucus, allergy creating particles and irritants such as pollens, dust particles, pollutants and bacteria are washed away, reducing the inflammation of the mucous membrane. Normal mucosa will fight infections and allergies better and will reduce the symptoms. Nasal irrigation helps shrink the sinus membranes and thus increases drainage. There are several over-the-counter nasal rinse products available. Consult your ear, nose, and throat specialist for directions on making a home nasal rinse or irrigation solution.
Over-the-counter medications: Some over-the-counter (OTC) drugs are highly effective in reducing sinus headache pain. The primary ingredient in most OTC pain relievers is aspirin, acetaminophen, ibuprofen, naproxen, or a combination of them. The best way to choose a pain reliever is by determining which of these ingredients works best for you.
Decongestants: Sinus pressure headaches caused by allergies are usually treated with decongestants and antihistamines. In difficult cases, nasal steroid sprays may be recommended.
Alternative medicine: Chinese herbalists use Magnolia Flower as a remedy for clogged sinus and nasal passages. In conjunction with other herbs, such as angelica, mint, and chrysanthemum, it is often recommended for upper respiratory tract infections and sinus headaches, although its effectiveness for these problems has not been scientifically confirmed.
If none of these preventative measures or treatments is effective, a visit to an ear, nose, and throat specialist may be warranted. During the examination, a CT scan of the sinuses may be ordered to determine the extent of blockage caused by chronic sinusitis. If no chronic sinusitis were found, treatment might then include allergy testing and desensitization (allergy shots). Acute sinusitis is treated with antibiotics and decongestants. If antibiotics fail to relieve the chronic sinusitis and accompanying headaches, endoscopic or image-guided surgery may be the recommended treatment.
Insight into complications and treatment
- What is a thyroid disorder?
- What treatment may be recommended?
- What is thyroid surgery?
- and more…
Your thyroid gland is one of the endocrine glands that makes hormones to regulate physiological functions in your body, like metabolism (heart rate, sweating, energy consumed). Other endocrine glands include the pituitary, adrenal, and parathyroid glands and specialized cells within the pancreas.
The thyroid gland is located in the middle of the lower neck, below the larynx (voice box) and wraps around the front half of the trachea (windpipe). It is shaped like a bow tie, just above the collarbones, having two halves (lobes) joined by a small tissue bar (isthmus.). You can’t always feel a normal thyroid gland.
What is a thyroid disorder?
Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are:
- An overactive gland, called hyperthyroidism (e.g., Graves’ disease, toxic adenoma or toxic nodular goiter)
- An underactive gland, called hypothyroidism (e.g., Hashimoto’s thyroiditis)
- Thyroid enlargement due to overactivity (as in Graves’ disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter.”
Patients with a family history of thyroid cancer or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy.
If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room.
What treatment may be recommended?
Depending on the nature of your condition, treatment may include the following:
Hypothyroidism treatment: Thyroid hormone replacement pills
- Medication to block the effects of excessive production of thyroid hormone
- Radioactive iodine to destroy the thyroid gland
- Surgical removal of the thyroid gland
If you experience this condition, your doctor will propose a treatment plan based on the examination and your test results. He may recommend:
- An imaging study to determine the size, location, and characteristics of any nodules within the gland. Types of imaging studies include CT or CAT scans, ultrasound, or MRIs.
- A fine-needle aspiration biopsy—a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, and tissue fluid samples containing cells are taken. Several passes with the needle may be required. Sometimes ultrasound is used to guide the needle into the nodule. There is little pain afterward and very few complications from the procedure. This test gives the doctor more information on the nature of the lump in your thyroid gland and may help to differentiate a benign from a malignant or cancerous thyroid mass.
- Thyroid surgery may be required when:
- the fine needle aspiration is reported as suspicious or suggestive of cancer
- imaging shows that nodules have worrisome characteristics or that nodules are getting bigger
- the trachea (windpipe) or esophagus are compressed because both lobes are very large
Historically, some thyroid nodules, including some that are malignant, have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical “suppression” therapy, has proven to be an unreliable treatment method.
What is thyroid surgery?
Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically, the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (immediate microscopic reading) may be used to determine if the rest of the thyroid gland should be removed during the same surgery.
Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This decision is usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you preoperatively.
As an alternative, your surgeon may choose to remove only one lobe and await the final pathology report before deciding if the remaining lobe needs to be removed. There also may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist to answer them in detail.
What happens after thyroid surgery?
During the first 24 hours:
After surgery, you may have a drain (tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the next day. Complications are rare but may include:
- Bleeding under the skin that rarely can cause shortness of breath requiring immediate medical evaluation
- A hoarse voice
- Difficulty swallowing
- Numbness of the skin on the neck
- Vocal cord paralysis
- Low blood calcium
Following the procedure, if it is determined that you need to take any medication, your surgeon will discuss this with you prior to your discharge. Medications may include:
- Thyroid hormone replacement
- Calcium and/or vitamin D replacement
Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon or seek medical attention:
- Numbness and tingling around the lips and hands
- Increasing pain
- Wound discharge
- Shortness of breath
If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant cells to lymph nodes or other sites in the body.
How is a diagnosis made?
The diagnosis of a thyroid function abnormality or a thyroid mass is made by taking a medical history and a physical examination. In addition, blood tests and imaging studies or fine-needle aspiration may be required. As part of the exam, your doctor will examine your neck and ask you to lift up your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps to feel the thyroid and any mass in it. Tests your doctor may order include:
- Evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
- An ultrasound examination of your neck and thyroid
- Blood tests of thyroid function
- A radioactive thyroid scan
- A fine-needle aspiration biopsy
- A chest X-ray
- A CT or MRI scan