The thyroid conditions that we treat at MOSA are mainly surgical thyroid problems, such as nodules, masses and tumors. If your thyroid hormones are off you should see an endocrinologist. If you have a nodule on your thyroid gland we normally order an ultrasound to see how big it is and what it looks like. If it’s bigger than 10mm it should be fine needle biopsied under ultrasound guidance. If the result is showing a benign mass (most common nodule is called colloid), we typically do not recommend surgery.

These benign nodules should only be removed (hemithyreoidectomy) if they cause symptoms, like pressure or breathing/swallowing problems. A good way to monitor these benign nodules are with regular ultrasound examinations. If the needle biopsy is questionable or malignant you will need a total thyreoidectomy and sometimes additional radioactive iodine treatment. If the entire gland is removed you will need life long thyroid medication, such as Synthroid. After thyroid surgery our patients often have a drain and stay in the hospital overnight to make sure there is no bleeding or swelling. The risk for hoarseness afterwards is roughly 1%, and can always be handled to restore the voice.

The salivary glands include the parotid glands which are situated in front of the ear, the submandibular glands located under the jaw line, and the sublingual gland which are found along the floor of the mouth under the tongue. Scattered  throughout the cheeks, lips, and palate are minor salivary glands. Fortunately the majority of salivary gland tumors are benign. The most common location for salivary gland tumors is the parotid gland. Salivary gland tumors do not vary in size with meals; salivary gland or salivary duct stone will present with swelling during meal time due obstruction of salivary flow. Salivary gland tumors tend to enlarge slowly and painlessly. Rapidly enlarging, painful tumors may be an infection or may be a cancer.  Any salivary gland swelling should be evaluated by an otolaryngologist; this may involve imaging studies (CT or ultrasound) or a biopsy (fine needle aspiration). If a tumor is identified your surgeon will recommend removal of the salivary gland (ie, parotidectomy) and if in cases of malignancy removal of lymph nodes in the area. Salivary gland stones are treated differently (see below)

Salivary gland stones occur most commonly in the submandibular gland and duct. The stones are like small pearls that form over many years due to deposition of calcium and phosphate in the ducts that drain saliva from the gland. When the stones become large enough, they block the flow of saliva and cause painful swelling of the salivary gland during meals. In many cases the stones may pass on their own, however in some cases the duct may be too small to allow passage of the stone(s). There are three techniques to remove stones:

• Dilation of the duct opening
  • This can often be performed in the office with local anesthesia.
• Sialoendoscopy
  • With the patient under general anesthesia, a small scope is inserted in to the duct and the stone is removed using a small retrieval basket. If the stone is not too big (less than 3-5 mm), this technique works well.
  • For patients with a history of recurrent salivary gland swelling without stones, narrowing of the ducts due to scarring is the problem. These areas of narrowing (stenosis) can be dilated with balloons using a technique similar to angioplasty for patients with heart disease. Salivary duct stenosis is often found in patients who have undergone external radiation therapy or radioactive iodine therapy following treatment of thyroid cancer. In many cases there may be no known cause for the stenosis, though it seems to be more common in women after menopause.
• Removal of the gland
  • For large stones unable to be removed using sialoendoscopy, removal of the salivary gland is the final option. Removal of the parotid gland or submandibular gland is performed under general anesthesia and requires an overnight stay in the hospital.

Recurrent salivary gland swelling, often due to conditions such as sialadenitis or salivary stones, can cause discomfort and recurrent infections. Treatment options by an ENT specialist may include conservative measures such as hydration, warm compresses, and gland massage to promote salivary flow and alleviate symptoms. In cases of persistent or severe swelling, minimally invasive procedures such as sialoendoscopy may be recommended to visualize and remove salivary stones or debris obstructing the ducts, thereby relieving symptoms and reducing the risk of recurrence.

Minimally invasive sialoendoscopy is a specialized procedure performed by an ENT specialist to diagnose and treat conditions affecting the salivary glands, such as sialolithiasis (salivary stones) or strictures. During the procedure, a small, flexible endoscope with a camera is inserted into the salivary duct to visualize the gland and identify any obstructions or abnormalities. Treatment options may include removing salivary stones using micro-instruments or laser lithotripsy, dilating strictures, or irrigating the ducts to clear blockages, ultimately restoring normal salivary gland function and alleviating symptoms such as pain, swelling, and infection.

Esophageal dilation is a therapeutic procedure performed by an ENT specialist to widen a narrowed or obstructed esophagus, often due to conditions such as esophageal strictures, Schatzki’s rings, or eosinophilic esophagitis. During the procedure, a specialized dilator or balloon catheter is inserted into the esophagus and gently inflated to stretch and widen the narrowed area. This helps improve swallowing function, alleviate symptoms such as dysphagia or food impaction, and reduce the risk of complications such as aspiration pneumonia. Esophageal dilation is typically performed under sedation or anesthesia in a controlled medical setting and may require multiple sessions for optimal results.

Zenker’s diverticulum is a pouch or outpouching that forms in the upper part of the esophagus, often causing symptoms such as dysphagia, regurgitation, or halitosis. Treatment options by an ENT specialist may include conservative measures such as dietary modifications, swallowing therapy, or lifestyle changes to manage symptoms. However, in cases of persistent or severe symptoms, surgical intervention such as endoscopic diverticulotomy or open surgical repair may be recommended to remove the diverticulum and restore normal esophageal anatomy and function, ultimately improving swallowing function and quality of life for the patient.