Head & Neck Surgery in Gandhinagar & Ahmedabad | Niraaya Hospital

The neck contains an extensive network of approximately 300 lymph nodes grouped into defined levels (I through VI) that drain lymphatic fluid from the entire head and neck region. When cancer arises at any head-neck site - the oral cavity, oropharynx, larynx, hypopharynx, thyroid, or salivary glands - it can spread via lymphatic channels to these regional nodes. Neck dissection is the surgical removal of these lymph nodes and the surrounding fibroadipose tissue, performed to control existing nodal disease and prevent further spread.

Neck dissection is performed when: lymph nodes are clinically enlarged and FNAC has confirmed metastatic cancer (therapeutic neck dissection), or when there is a high enough statistical risk of microscopic nodal disease (occult metastasis) even when nodes are clinically not palpable - based on the primary tumour site, size, and histological features (elective neck dissection).

Removes only the lymph node levels statistically at highest risk from a given primary tumour site - for example, levels I-III for oral cavity cancer, or levels II-IV for laryngeal cancer - while preserving all non-lymphatic structures: the sternocleidomastoid (SCM) muscle, internal jugular vein (IJV), and accessory nerve (CN XI, which innervates the trapezius and SCM muscles and is critical for shoulder movement). SND is the standard approach for most early-stage head-neck cancers, offering excellent oncological control with minimal functional morbidity.

Removes all five cervical lymph node levels (I through V) while preserving one or more of the three major non-lymphatic structures. The most common variant preserves the accessory nerve (preventing shoulder drop) while sacrificing the SCM and IJV when necessary. Used for more extensive nodal disease.

Removes all five lymph node levels along with the SCM muscle, IJV, and accessory nerve. The most extensive form, associated with significant shoulder drop and neck contour change. Reserved for disease where these structures are directly involved by cancer or when sacrifice is unavoidable for complete cancer clearance.

Dr. Khushali Patel performs neck dissection with meticulous anatomical dissection - identifying and preserving the accessory nerve, hypoglossal nerve, lingual nerve, vagus nerve, phrenic nerve, and brachial plexus - minimising post-operative shoulder weakness, swallowing problems, and numbness, while achieving complete cancer clearance.

The parotid gland is the largest salivary gland, sitting in front of and below the ear on each side of the face. The facial nerve (the nerve controlling all facial expression) divides into its five main branches (temporal, zygomatic, buccal, marginal mandibular, and cervical) within the substance of the parotid gland before reaching the facial muscles - making parotid surgery uniquely challenging.

Parotidectomy is performed for: benign parotid tumours (pleomorphic adenoma - the most common, accounting for 70% of parotid tumours; Warthin's tumour - the second most common, bilateral in 10% of cases); malignant parotid tumours (mucoepidermoid carcinoma, adenoid cystic carcinoma, acinic cell carcinoma); chronic parotitis with irreversibly damaged gland; and parotid lymph node disease.

A pre-auricular incision (in front of the ear) curves behind the ear lobule and extends into the neck - designed to be as inconspicuous as possible. The superficial lobe of the parotid (the portion superficial to the plane of the facial nerve) is dissected off the facial nerve branches in their entirety - this requires patient, methodical dissection identifying each nerve branch at its emergence from the stylomastoid foramen. Superficial parotidectomy (removal of the superficial lobe alone) is adequate for most benign tumours. Total parotidectomy - removing both superficial and deep lobes - is performed for malignant tumours or tumours of the deep lobe, with nerve-preserving or nerve-sacrificing technique depending on nerve involvement.

The submandibular gland sits beneath the jaw on each side, in the submandibular triangle. Excision is performed for: chronic sialadenitis (recurrent painful gland swelling from salivary duct stones - sialolithiasis - blocking the Wharton's duct); large submandibular duct stones not amenable to endoscopic removal; and submandibular gland tumours (15% of all salivary gland tumours occur here - and a higher proportion are malignant compared to the parotid gland).

A skin crease incision below the lower border of the mandible provides access. Critical structures preserved during surgery include: the marginal mandibular branch of the facial nerve (controlling the lower lip - its injury causes a visible cosmetic and functional asymmetry), the lingual nerve (controlling sensation to the anterior tongue), and the hypoglossal nerve (controlling tongue movement).

Thyroidectomy is the surgical removal of part or all of the thyroid gland - a butterfly-shaped endocrine gland wrapping around the anterior trachea in the lower neck, producing thyroxine (T4) and triiodothyronine (T3) which regulate the body's metabolic rate, cardiac function, growth, and development. Thyroid surgery involves two critical structures that must be meticulously identified and preserved: the recurrent laryngeal nerves (RLNs) - branches of the vagus nerve that loop around the subclavian and aortic arch before ascending to innervate the vocal cord muscles - and the parathyroid glands - four tiny (3-5 mm) glands embedded in or adjacent to the posterior thyroid capsule that regulate serum calcium.

Removal of one thyroid lobe along with the isthmus (the bridge connecting both lobes). Indications include: a solitary indeterminate or follicular thyroid nodule (Bethesda Category III or IV on FNAC), a single lobe thyroid cancer meeting criteria for lobectomy (selected papillary microcarcinomas), and a dominant symptomatic nodule in one lobe. The remaining lobe may be sufficient to maintain normal thyroid function without medication in many patients.

Removal of the entire thyroid gland. Indications include: differentiated thyroid cancer (papillary and follicular), where total thyroidectomy allows subsequent radioiodine (I-131) therapy to ablate any residual thyroid tissue and metastases; medullary thyroid cancer; large multinodular goitre causing compression (dysphagia, dysphonia, dyspnoea); Graves' hyperthyroidism resistant to anti-thyroid medication; and any thyroid cancer in a patient with pre-existing contralateral thyroid disease.

The skin incision is placed in a natural neck skin crease, approximately 3-5 cm in length for a hemithyroidectomy and 5-7 cm for a total thyroidectomy. The strap muscles of the neck are retracted, and the thyroid lobe is carefully mobilised. The RLN is identified early in the dissection - traced from its entry into the larynx, following it in a retrograde direction through the tracheo-oesophageal groove. The parathyroid glands are individually identified and their blood supply (from small branches of the inferior thyroid artery) is carefully preserved - inadvertent removal or devascularisation of all four parathyroid glands causes permanent hypocalcaemia. The thyroid lobe is divided and removed. A careful pre-operative flexible laryngoscopy confirms normal bilateral vocal cord function, and post-operative laryngoscopy assesses cord function at follow-up.

Hospital stay: 1-2 nights for total thyroidectomy (calcium monitoring for 24-48 hours); 1 night for hemithyroidectomy. Calcium supplementation if required. Wound care: scar management with silicone gel or sheets from 2 weeks post-operatively. Return to normal activities: 2-3 weeks. Lifelong thyroxine replacement after total thyroidectomy.