Prof. (Dr.) Indranath Kundu
M.S. (Cal) Gold Medalist, D.N.B. (New Delhi)
Senior Consultant E.N.T. Surgeon
DEPARTMENT OF E.N.T.
     
  drinkundu@rediffmail.com +91 98300 35217
+033 2358 1260
 
Throat Surgery:
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1. Phono Surgery:
Surgical procedures that maintain, restore, or enhance the human voice. Phonosurgery includes phonomicrosurgery (microsurgery of the vocal folds done through an endoscope), laryngoplastic phonosurgery (open-neck surgery that restructures the cartilaginous framework of the larynx and the soft tissues), laryngeal injection (injection into the larynx of medications as well as synthetic and organic biologic substances), and reinnervation (restoration of the nerve supply) of the larynx. The term "phonosurgery" was coined in the early 1960s.

2. Adenoidectomy:
Adenoidectomy is the surgical removal of the adenoids. They may be removed for several reasons, including impaired breathing through the nose and chronic infections or earaches. The surgery is less common for adults. It is most often done on an outpatient basis under general anesthesia. Post-operative pain is generally minimal and prevented with an abundance of icy or cold foods. Spicy foods, such as jalapeños or curries, should be avoided. The procedure can sometimes be combined with a tonsillectomy if needed. Recovery time can range from several hours to two or three days (though as age increases so does recovery time).

Adenoidectomy is not often performed on children under 1 year old as adenoids help the body's immune system but their value decreases rapidly once children reach this age. Adenoids become vestigial organs in adults.

3. Cleft Lip & Palate:
Cleft lip (cheiloschisis) and cleft palate (palatoschisis), which can also occur together as cleft lip and palate, are variations of a type of clefting congenital deformity caused by abnormal facial development during gestation. A cleft is a fissure or opening—a gap. It is the non-fusion of the body's natural structures that form before birth. Approximately 1 in 700 children born have a cleft lip and/or a cleft palate. In decades past, the condition was sometimes referred to as harelip, based on the similarity to the cleft in the lip of a hare, but that term is now generally considered to be offensive.

Clefts can also affect other parts of the face, such as the eyes, ears, nose, cheeks, and forehead. In 1976, Paul Tessier described fifteen lines of cleft. Most of these craniofacial clefts are even more rare and are frequently described as Tessier clefts using the numerical locator devised by Tessier.
A cleft lip or palate can be successfully treated with surgery, especially so if conducted soon after birth or in early childhood.

4. Tonsillectomy:
A tonsillectomy is a 3,000-year-old surgical procedure in which the tonsils are removed from either side of the throat. The procedure is performed in response to cases of repeated occurrence of acute tonsillitis or adenoiditis, obstructive sleep apnea, nasal airway obstruction, snoring, or peritonsillar abscess. For children, the adenoids are removed at the same time, a procedure called adenoidectomy. This is not common for adults. Although tonsillectomy is being performed less frequently than in the 1950s, it remains one of the most common surgical procedures in children in the United States. After the procedure when the patients fully recovered, they will have a noticeable difference with the sound of their voice.

5. Thyroid Swelling:
A goitre is an enlarged thyroid gland. A goitre can mean that all the thyroid gland is swollen or enlarged, or one or more swellings or lumps develop in a part or parts of the thyroid.

The thyroid gland is in the lower part of the front of the neck. It lies just in front of the windpipe (trachea). It has a right and left lobe which are connected together by a narrow band of thyroid tissue. It is roughly the shape of a butterfly. You cannot usually see or feel a normal thyroid gland.

The thyroid gland makes thyroid hormones - called thyroxine (T4) and triiodothyronine (T3). These hormones are carried round the body in the bloodstream. Thyroxine and T3 help to keep the body's functions (the metabolism) working at the correct pace. Many cells and tissues in the body need thyroxine and T3 to keep them working correctly.

6. Surgery for Parotid & Submandibular Salivary Gland Swelling

The paired submandibular glands (submaxillary glands) are salivary glands located beneath the floor of the mouth. In humans, they account for 70% of the salivary volume and weigh about 15 grams. Unstimulated (at rest) in humans, the percentage contribution to whole saliva; ~25% Parotid, Submandibular and Sublingual ~ 67% and ~8% minor mucous glands. During stimulated secretion the parotid gland produces majority of the saliva.

The parotid gland is a salivary gland in humans. It is one of a pair, and the largest of the salivary glands. It is wrapped around the mandibular ramus, and secretes saliva through Stensen's ducts into the oral cavity, to facilitate mastication and swallowing and to begin the digestion of starches.

7. Tumour of Pharynx & Larynx E.G. Total & Partial Laryngectomy & Voice Rehabilitation


8. Neck Dissection:
The neck dissection is a surgical procedure for control of neck lymph node metastasis from tumours (most commonly Squamous cell carcinoma and Merkel cell carcinoma) of the head and neck. The aim of the procedure is to remove lymph nodes from one side of the neck into which cancer cells may have migrated. Metastasis of tumours into the lymph nodes of the neck reduce survival and is the most important factor in the spread of the disease. The metastases may originate from tumours of the upper aerodigestive tract, including the oral cavity, tongue, nasopharynx, oropharynx, hypopharynx, and larynx, as well as the thyroid, parotid and posterior scalp.

9. Tongue Tumour:
In oncology squamous cell cancers of the head and neck are often considered together because they share many similarities - in incidence, cancer type, predisposing factors, pathological features, treatment and prognosis. Up to 30% of patients with one primary head and neck tumour will have a second primary malignancy.The oral cavity or mouth consists of two parts: the vestibule- which is the space between the lips and cheeks and the teeth and gums; and the mouth proper- which is internal to the teeth. The oral cavity refers to the entire contents of this area - including the cheeks, gums, teeth, tongue and palate. The functions of this region include ingestion and the first phases of digestion of food (mechanical destruction by the teeth through chewing), taste, respiration and the function of speech (the movements of the oral cavity and its components shape the sounds produced by the larynx into words).The tongue is a very mobile muscular organ that, at rest, fills most of the oral cavity. It has many roles including taste, chewing (mastication), swallowing (deglutition), speech and cleaning the oral cavity. Its major roles are to propel a bolus of food backwards and into the pharynx to initiate swallowing and forming words to enable communication. It arises from the floor of the mouth, partly in the oropharynx, and consists of muscles covered by mucous membranes.

10. Esophagoscopy:
Esophagoscopy is a procedure in which a flexible endoscope is inserted through the mouth, or more rarely, through the nares, and into the esophagus. The endoscope uses a charge-coupled device to display magnified images on a video screen. The procedure allows visualization of the esophageal mucosa from the upper esophageal sphincter all the way to the esophageal gastric junction, or EG junction.

This procedure is one of several procedures that fall under the category of upper endoscopy, including gastroscopy, esophagogastroduodenoscopy (EGD), and enteroscopy. Esophagoscopy alone is uncommon, as it is generally performed as part of a more complete upper endoscopic procedure in which the esophagus, stomach, and portions of the small intestine are explored endoscopically.

In the United States, esophagoscopy is usually performed under moderate sedation, which is achieved by administering a narcotic and benzodiazepine in combination. In Europe and Asia, however, the procedure is commonly performed without the use of sedation. Topical anesthesia is sometimes implemented to improve patient tolerance and comfort. Very seldom general anesthesia is used in patients who are difficult to sedate or are at higher risk of airway compromise. The following topic focuses on transoral esophagoscopy. For information regarding transnasal esophagoscopy, see the article Transnasal Esophagoscopy.

11. Bronchoscopy:
Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs. The construction of bronchoscopes ranges from rigid metal tubes with attached lighting devices to flexible optical fiber instruments with realtime video equipment.

12. Microlaryngoscopy:
Microlaryngoscopy is the examination of your larynx (voice box) while you are under a general anaesthetic. Microlaryngoscopy is done to find and treat problems of the voice box, such as hoarseness.
Your surgeon will put a short metal tube (a laryngoscope) through your mouth into your voice box. A microscope is then used to look into the voice box to find what the problem is. If needed, surgery on your voice box can also be done through the laryngoscope.
If there are any problem areas, a small part of the lining of the voice box is taken away for laboratory examination. This is called a biopsy. Depending on the type of lesion a laser is sometimes used to remove it.
Microlaryngoscopy is quite a short operation and usually takes less than 30 minutes.

13. Direct Laryngoscopy:
Laryngoscopy is a simple procedure that allows a doctor to view the voice box in the throat. The voice box or larynx and vocal cords allow you to sing and speak. Sometimes certain cells overgrow in this box and have to be removed. That is why we call a doctor. A doctor can conduct two different types of laryngectomy. An advanced indirect laryngoscopy can occur at your doctor’s office. If a handheld mirrors is held to the back of the throat the doctor can shine a light into your moth and wear a mirror on his or her head to reflect light (or they can just by a helmet with the light built in).
 
A better option is the direct fiber-optic laryngoscopy which uses a flexible or rigid laryngoscopy instrument. This procedure helps doctors find the cause for voice problems, ear pain, swallowing troubles, lumps in throats or narrowing of the throat.

14. Benign Neck Swellings:
Neck swelling is an accumulation of fluid in the neck tissues or inflammation in the neck. Neck inflammation can arise from an infection, injury, or a recent medical procedure. Benign skin conditions can cause small areas of the neck to appear swollen. Swelling of the lymph nodes in the neck is a common symptom of many different types of viral and bacterial infections. In rare cases, neck swelling can be a result of cancer.

In mild cases of neck swelling, treatment may not be required. If the neck swelling is bothersome, over-the-counter medications such as anti-inflammatory drugs or pain medications or cold compresses may help reduce discomfort and swelling. In more serious cases, a visit to a medical professional may be necessary to determine the cause of neck swelling and appropriate treatment.