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New Ways to Treat Head and Neck Disorders

January 18, 2022

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Community Conversation: Tom Thomas, MD

While only 6% of cancers are of the head and neck, those who develop them often experience debilitating symptoms that severely impact their quality of life.

Tom Thomas, MD, MPH, director of Head and Neck Reconstructive and Transoral Robotic Surgery and director of Sleep Surgery at Morristown Medical Center, joined a Community Conversation on December 10, 2021 to share ways you can prevent head and neck cancers. He also talked about new technologies that help patients with debilitating sleep apnea and answered questions from viewers.

What causes head and neck cancer and what are the signs?

Dr. Thomas said we are in the midst of an epidemic of a viral disease called HPV (human papillomavirus) that causes the majority of head and neck cancers.

Dr. Thomas explained that before the HPV epidemic, people who developed head and neck cancer were primarily those over the age of 60 who used tobacco products or drank alcohol. Because of the HPV epidemic, the condition often afflicts those earlier in life, in their 40s and 50s.

The usual indicators are a neck lump that is not going away or a sore throat that does not get better after antibiotic treatment.

How does Atlantic Health System care for patients with head and neck cancer?

Atlantic Health System provides comprehensive care and evidence-based treatment for head and neck cancer. A multidisciplinary team including surgeons, radiation oncologists, medical oncologists, speech and language pathologists and nutritionists, come together to care for patients, based on their individual needs.

How are patients treated for head and neck cancer?

Throat cancer used to require invasive surgery, according to Dr. Thomas. Incisions were large and patients often needed a tracheostomy and a feeding tube. Today, robotic surgery, transoral robotic surgery and transoral laser surgery have transformed treatment for the condition. For many patients, cancers can be removed through the mouth in as little as 30 to 40 minutes. Less invasive surgery translates to quicker recovery times and better outcomes for swallowing, breathing, and talking after surgery.

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Is there a vaccine for HPV?

Gardasil-9, the latest iteration of the HPV vaccine, is available for children ages nine and older. The HPV vaccine is FDA-approved and is safe and effective. Dr. Thomas added that HPV is a sexually transmitted disease, so ideally, you want to get the vaccine prior to the initiation of sexual activity. The earlier you receive the vaccine, the stronger the immunogenic response. The FDA has approved the vaccine for those up to the age of 45. The vaccine can be accessed through a pediatrician or a primary care physician.

Need a primary care doctor? Find one here >

How important is early detection of head and neck cancer?

Dr. Thomas said that during the COVID-19 pandemic, many people delayed access to preventive health care or missed screenings that could have detected cancer and developed advanced stage disease as a result. He emphasized the importance of developing a relationship with a primary care physician.

“Catching something early is always better,” he said.

What other conditions that affect the head and neck are treated at Atlantic Health System?

Atlantic Health System physicians treat the entire spectrum of cancers of the head and neck. Dr. Thomas said, “As a head and neck cancer surgeon, I treat comprehensive ailments of the head and neck … (including) skin cancers, basal cell carcinoma, squamous cell carcinoma, or melanoma, thyroid cancer, parathyroid cancers, salivary gland cancers and tongue cancers.”

How long after a full removal of the thyroid does throat soreness and voice hoarseness last?

Dr. Thomas said that a thyroidectomy is a common procedure and that a sore throat and changes in the voice should not last more than seven to 10 days. If it is lasts longer, the patient should consult their surgeon for an evaluation.

Is sleep apnea part of the head and neck conditions treated by Atlantic Health System?

Sleep apnea affects 25% of the adult population in the United States and is treated by the doctors and surgeons of Atlantic Health System, Dr. Thomas said. Patients are diagnosed through their primary care physician and evaluated by a sleep study. The most common treatment option is a CPAP (continuous positive airway pressure), which uses a mask that goes over your face while you sleep. Dr. Thomas said that many people find the device cumbersome.

“If you move around in bed or if you’re claustrophobic, that mask comes off and the compliance rate is almost 50% or less, so we are left with a huge chunk of the population who has a serious condition, but we don’t have a treatment for it.

Are surgical options available for sleep apnea?

Atlantic Health System offers surgery for obstructive sleep apnea and sinonasal diseases. Patients are evaluated to find out where an obstruction is taking place – the nose, sinuses, or back of the throat – and to determine if the condition can be improved with surgery. If surgery is not an option, Dr. Thomas said patients may be helped through the use of a recent technology called hypoglossal nerve stimulation.

What is hypoglossal nerve stimulation?

Hypoglossal nerve stimulation addresses the obstruction of air by the tongue during sleep through the surgical implantation of a device that provides a long-term therapeutic solution for obstructive sleep apnea, Dr. Thomas said. He explained that the device is smaller than a cardiac pacemaker and is implanted in the chest. The device is then connected to the nerves of the tongue. Dr. Thomas said many patients experience a decrease in their apnea hypopnea index as a result of the device.

Who is eligible for this type of surgery?

Adults who have had a sleep study (or polysomnogram) that took place in the past two years and have an apnea hypopnea index between 15 to 65, along with a certain body mass index, may qualify.

How can patients find out if they should have a sleep study?

Dr. Thomas said the first step is to meet with a sleep physician to determine your condition and to find more information.

Learn more about sleep studies and treatment >

How does the surgical implant impact a person's quality of life?

“From my experience…patients are ecstatic about this implant,” said Dr. Thomas. “One, there's nothing that you can see. They go to bed like everybody else. There is no machine. They can sleep on their side, sleep on their stomach, or in any position they want. They can go camping. They can travel without lugging around a big suitcase. It definitely has been transformative for patients.”

What future breakthroughs are possible for neck and head disorders?

Dr. Thomas expressed confidence in the scientific and technological breakthroughs that will help head and neck cancer patients and non-cancer patients in the future. He spoke about innovations that are currently underway, including robotic surgery, vaccines that can prevent certain cancers from occurring, blood and saliva tests and transformations in the treatment of sleep apnea. “I'm very optimistic about how things are.”