Head and Neck Cancer

Over 50,000 people are diagnosed with some form of head and neck cancer each year within the USA.

Head and Neck cancer treatment requires a multidisciplinary approach to care involving surgeons, radiation oncologists, medical oncologists, speech/language pathologists, maxillofacial prosthodontists, nutritionists and rehabilitation therapists.

The Oncology team at UMOMSA are an experienced team of surgeons with a focus on the surgical management (ablation and reconstruction) of cancers of the head and neck.

Drs. Donita DyalramJoshua Lubek and Robert Ord are all active members of the multidisciplinary head and neck cancer team at the University of Maryland Greenebaum Comprehensive Cancer Center.

Jaw Tumor Surgery

Tumors and cysts of the jaws represent a diverse group of diseases that can originate from both tooth-related structures (odontogenic) and non-tooth-related (non-odontogenic) sources within the jaws, including:

  • Cysts associated with impacted teeth can very often be treated with curettage of the cyst and removal associated tooth
  • Jaw tumors such as ameloblastoma or myxoma require a more aggressive approach with surgical resection of the jaw to ensure complete removal and minimize chance of recurrence
  • Patients requiring surgical removal of these tumors can often have immediate jaw reconstruction with microvascular free flaps and simultaneous dental implant replacement
  • Other less aggressive tumors such as fibro-osseous tumors and giant cell lesions can often be treated with removal and preservation of the surrounding jaw and facial bone structure

Some jaw tumors can be associated with systemic conditions, including:

  • Giant cell tumors and parathyroid disease
  • Keratocysts of the jaws and basal cell nevus syndrome

Following treatment of such diseases, the UMOMSA team will continue to follow patients closely to watch for any signs of recurrence with clinical exam and various radiographic imaging techniques (orthopantomogram and CT scan).

Minimally Invasive Robotic Surgery

Treatment of cancers of the tongue base and throat can leave patients with significant swallowing problems.

Robotic surgery has the advantages of decreased swallow dysfunction, reduced hospitalization/recovery and potentially eliminating the need for radiation or chemoradiation therapy.

Transoral robotic surgery allows access to tumors of the tongue base and tonsil through minimally invasive access approaches thereby improving appearance and eliminating the need for formal reconstructive surgery.

Neck Masses

Neck masses represent a diverse group of diseases that can develop within the head and neck.

There are 3 broad categories of neck masses.

  • Congenital (ie. branchial cleft cyst, thyroglossal duct cyst)
  • Inflammatory/Infectious
  • Neoplastic (benign and malignant tumors)

Malignant growths can be associated with cancers of the head and neck originating from the oral cavity, oropharynx, throat or thyroid.

Other cancers such as lymphoma can also present with a neck mass.

At your consultation the UMOMSA faculty will perform a detailed history and clinical exam that may also include the use of a specialized fiberoptic camera to look at structures within the mouth and throat.

Patients will likely require imaging with CT scan, MRI or ultrasound to help visualize the neck mass.

Biopsy may be performed in the office setting using a needle technique or with an open surgical technique in the operating room under general anesthesia as an outpatient day case.

Oral Pathology

The oral cavity has a specialized skin (mucosa) that can be affected by various disease processes. Although natural pigment may occur, the mucosa is generally smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following can be signs at the beginning of a pathological process or cancerous growth:

  • Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth
  • A sore that fails to heal and bleeds easily
  • A lump or thickening on the skin lining the inside of the mouth
  • Chronic sore throat or hoarseness and/or difficulty in chewing or swallowing

Biopsy is considered the gold standard to establish a diagnosis, often able to be performed in the UMOMSA office.

Pre-cancerous lesions such as dysplasia can often be managed by laser removal in the comfort of the UMOMSA office.

Drs. Donita DyalramJoshua Lubek and Robert Ord are experts in the management of oral cancer and pre-malignant disease (oral dysplasia) and provide comprehensive compassionate care during all phases of treatment (diagnosis, treatment, reconstruction and surveillance).

Drs. Donita Dyalram and Joshua Lubek are trained in minimally invasive techniques using robotic surgery (TORS) to access and surgically remove tumors and growths of the oral cavity and oropharynx (tonsil and tongue base).

Salivary Gland Disease

The salivary glands are specialized glands that produce saliva that drain into the mouth and throat.

The major glands (parotid, submandibular, sublingual glands) are paired glands that drain into the mouth.

The minor salivary glands are located throughout the oral cavity, palate and throat.

The two most common problems associated with salivary gland disease include obstructive diseases (result of salivary stones or trauma) and tumors (can be either benign or malignant).

Salivary gland cancers are rare accounting for 3-6 percent of all head and neck cancers.

Patients referred for management of salivary disease will often require advanced imaging techniques such as CT scan, MRI (magnetic resonance imaging) or ultrasound guided imaging with biopsy to help establish a diagnosis.

Skin Cancer of the Face

Skin cancer is an abnormal growth of cells of the skin.

It is most often caused by sun exposure/damage.

Skin cancer can occur in all people regardless of skin color or pigmentation.

Basal cell carcinoma is the most common form of skin cancer.

Actinic keratosis is a risk factor for developing skin cancer often occurring on the lower lip and face.

Melanoma accounts for less than 1 percent of all skin cancers but the majority of skin cancer deaths.

Squamous cell carcinoma and melanoma can occur within the oral cavity and are not related to sun exposure.

The UMOMSA team advocates safe sun practice with proper clothing, hats and sunscreens with at least an SPF of 15.

The UMOMSA Head & Neck Cancer team utilize various techniques including laser therapy and surgery to treat both pre-cancerous and cancerous skin lesions.

Surgical reconstruction is performed both in the UMOMSA office practice (650 West Baltimore St, Ste. 1401) or at the University of Maryland Medical Center.

Vascular Tumors/Malformations

The most common vascular tumor of childhood is the hemangioma. Approximately 60% of hemangiomas occur within the head and neck

Vascular malformations include low-flow malformations of capillaries or veins and high-flow malformations of arteries. The majority of lymphatic malformations develop within the head and neck often occurring within the tongue causing symptoms of speech impairment, swelling and swallowing dysfunction.

Treatment includes both non-surgical (sclerotherapy) and surgical removal with reconstruction. The UMOMSA faculty work closely with interventional radiologists/vascular surgeons from the University of Maryland as embolization procedures are often needed prior to definitive surgical therapy.