However, surgeons at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine are using a different approach that avoids cutting a patient’s face and neck, instead using a face’s existing openings.
Called transoral laser microsurgery (TLM), it’s a minimally invasive technique that Bruce Haughey, MD, director of head and neck cancer surgery at Siteman, has perfected over the last decade and is now teaching surgeons around the country.
“It’s an efficient way to manage head and neck cancer by avoiding external incisions and perhaps more importantly, avoiding the dismantling the face’s musculoskeletal structure,” says Dr. Haughey.
It’s estimated there are about 29,000 new cases of head and neck cancer diagnosed annually in the United States. The treatment of head and neck cancers has a dual focus: eliminating the cancers that affect the mouth, throat, voice box, upper swallowing passage or skull base and providing the latest reconstructive procedures to restore patients’ appearance and ability to communicate and swallow.
“Traditionally, these areas have been approached by very wide operations where large incisions are made on the face and neck,” says Dr. Haughey. “Because this is cancer surgery, these are large operations with safety margins to make sure that cancer is removed.”
Dr. Haughey says the unfortunate side effects of that procedure can be functional losses, scarring and prolonged recoveries that really can set patients back with communication, eating and swallowing difficulties. With TLM however, surgeons work through the mouth to find structures in the throat using an operating microscope and laser to surgically eradicate the cancer.
“We use the preexisting cavities of the head to access these regions where the disease is located,” says Dr. Haughey. “We pass endoscopes through the nostrils or the mouth and work around corners to reach these regions.”
Not only is the procedure less invasive, it also offers quicker recovery. “There’s tremendous efficiency in terms of time,” says Dr. Haughey. “Time spent in the hospital after surgery is reduced by 50% or more and the functional recovery of speech and special senses all return much more quickly.”
TLM is primarily for those with hard to reach tumors. For patients with large tumors the procedure is usually only available at large volume centers like Siteman. Dr. Haughey had performed over 400 TLM procedures.
“We’ve been collaborating with colleagues at Mayo Clinic on TLM and are teaching this more widely,” says Dr. Haughey. “We taught a course in May to a select group of head and neck specialists from around the country and as time progresses I think you will hear more about the procedure.”
For more information about head and neck cancer or transoral laser microsurgery, visit www.siteman.wustl.edu or call 800-600-3606.