Chapter 7: Head and Neck Surgery

INTRODUCTION

Head and neck cancers account for a significant portion of annual incidence of cancers in the United States. Although not as prevalent as breast, lung, or colon cancer, head and neck malignancies represent over 10% of all cancers diagnosed each year, accounting for over 100,000 patients diagnosed with head and neck malignancies.¹ Despite the large numbers of newly diagnosed patients every year, the mortality rate from head and neck malignancies consistently hovers around 4% of total deaths from cancers in the United States.² This low mortality rate is due to the good response to treatment modalities for cancers originating in the head and neck. The traditional therapies of surgical resection, chemotherapy and radiation treatment, and the newer therapies of immunomodulation treatment, have all contributed to the increased survival rate of patients with head and neck cancer. However, patients still experience poor outcomes and surgical complications, which may result in alleged wrongdoing by health care professionals. This chapter will focus on the areas of head and neck malignancies with respect to the disease in particular anatomic locations and the resulting cause of the potential allegations of medical malpractice. This chapter will also discuss aspects of care of head and neck cancer patients that may minimize the potential risk of malpractice claims.

HEAD AND NECK MALIGNANCIES

The head and neck anatomy is composed of a complex system of cranial nerves, elaborate vasculatures, and an intricate group of muscles that provide the primary tool for human communication and allow for continued sustenance by processing the food eaten for later digestion. As a result, treatment of malignancies in the head and neck may result in mild to severe alterations of the most basic human functions. From extirpative resection of the face causing disfigurement to laryngectomies that decimate the ability to talk and glossectomies resulting in the loss of the ability to swallow, all patients will need pretreatment counseling and posttreatment rehabilitation. Knowledge of the various head and neck malignancies will better prepare the health care professional to diagnose, treat, and rehabilitate the patient.

Skin

Skin cancer is the most common malignancy in the United States, and a sizeable percentage arise in the head and neck area.³ The most common types of skin cancer are nonmelanoma skin cancers and melanoma skin cancers. Nonmelanoma skin cancers comprise basal cell carcinoma and squamous cell carcinoma, with an incidence ratio of 3 to 1.⁴ Although malignant melanoma accounts for only 5% of all skin cancers, it accounts for 75% of deaths from skin cancers.² Health care professionals who specialize in the head and neck area must be vigilant in monitoring for suspicious skin lesions, especially in population groups that are more susceptible to skin cancers, for example, patients with fair skin and light hair, patients with a history of sun exposure, and patients with a family history of ...