This is not a new discipline but certainly one that is poorly understood. The reason for the confusion is that it brings together a collection of diseases from different disciplines into one discipline. The different disciplines primarily include ENT, general surgery, and oral and maxillofacial surgery. It does not involve the spine or brain and therefore not the neurosurgeons as is sometimes thought.
When I say to patients and colleagues of other disciplines that I am an ENT they often think of tonsils, grommets, sinus surgery and ear surgery. These are not my main areas of interest and so now I introduce myself as a head and neck surgeon even though I still do general ENT work. What does that mean? Briefly, head and neck surgery focuses on masses and ulcers in the head and neck. There will be a blog to come on the approach I have to neck masses, but to summarise most masses fall into the category of either from embryological, inflammatory or neoplastic origin.
Head and neck surgery as a discipline came out of general surgery, but as technology such as endoscopes improved our ability to examine patients, it was the ENT who was well positioned to do more head and neck surgery. Most neoplastic masses arise with primaries in the upper aero-digestive tract that metastasise to the neck nodes and the ENTs examine these areas best.
Dentists examining the teeth would sometimes pick up concerning ulcers or growths and refer to general surgeons, but as the discipline of maxillofacial surgery developed, more and more maxillofacial surgeons treated tumours of the mouth.
General surgeons have for a long time treated thyroid nodules and goitres as well as salivary masses, but more and more of these are done by ENTs worldwide.
Clearly there is overlap between what different disciplines have traditionally been taught, but out of necessity related to particularly the complex nature of cancers, head and neck surgery has become a discipline on its own. That’s not to say the head and neck surgeon can comprehensively treat all aspects of head and neck masses themselves. In order to get the best possible outcome from both a cure and quality of life perspective, multidisciplinary teamwork is essential.
Here at Morningside Mediclinic we have such a team that meet weekly to discuss patients with complex head and neck problems, focusing on mostly cancer.