Thyroid and head and neck surgery

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About thyroid and head and neck surgery

In these toggles, we’ve provided some general information about the procedure. For specific information about how we can help you, contact us for a consultation.

What will happen during my Thyroid surgery (or Parathyroid surgery)?

You will be given general anesthesia to put you to sleep. A skin cut is made at the base of your neck and is about three to four inches long. I will keep it as short as possible and if possible, will place it in one of your normal skin creases.

Using magnifying lenses, I locate the thyroid gland and associated structures, and remove all or part of the thyroid. In some cases, additional surgery will involve the removal of lymph nodes and other structures.

During the parathyroid removal, I will locate the enlarged parathyroid gland using your scan and remove it.

I stitch the cut closed and then cover it with a dressing. The operation generally lasts from two to three hours. After surgery, you will stay in the recovery room for several hours. You will be monitored closely as you recover from the anesthesia.

What should you expect after surgery?

After the surgery, you will have a liquid diet for dinner. You may have a sore throat and neck, which can be easily controlled with simple painkillers. Let the nurse know if your pain is more severe, as they will give you stronger pain medicine.

You may have a plastic tube coming out from the skin (drain) that works to prevent any blood collecting in your neck. You will have a dressing on your neck, which will be removed in the morning. You will have routine blood tests and will be offered regular food the next morning. Most people are ready to go home after the drain tube comes out.

How will you feel after surgery?

Everyone is different. You will most likely be tired and a bit sore for a few days. You may have pain not only from your incision but also from muscle soreness in your neck, upper back, and shoulders. This is from the positioning in the operating room during the surgery. We will give you appropriate painkillers for taking at home.

Your neck may be slightly swollen, and you may feel like you have a lump in your throat when you swallow. This will improve after a few days but may continue for a week or so.

What are the known common complications of thyroid surgery?

As with any surgical procedure, there are risks with thyroid or parathyroid surgery. In addition to the general risks such as bleeding, infection e.t.c, the two most important risks are:

Injury of the nerve to the vocal cords (recurrent laryngeal nerve and external laryngeal nerve)

In most thyroid surgery, one or both of the thyroid lobes will be removed. The surgeon must utilise proper technique to avoid injury to the nerves or the vocal cords. Failure to do so can cause injury to the nerve and result in paralysis of one or both vocal cords. Fortunately, in skilled hands, this complication is rare (less than 1%).

This risk is higher if you are having a second operation or if the cancer has spread out of thyroid gland.

Damage of this nerve leads to a significant change in voice, which may or may not recover. Although there are procedures to improve the voice should this occur, they cannot fully replicate your previous voice with perfection. Very rarely, while having an operation to remove the complete gland, both the left and the right nerve may be damaged (less than 0.001%). If this happens, you will find it difficult to breath and may need a breathing tube inserted in your windpipe through your neck.

Injury to the parathyroid glands

The parathyroid glands, four in number, lie behind the thyroid gland. They share some common blood supply with the thyroid and are quite small (about 1cm each). They are very active little glands, producing a hormone called parathyroid hormone (PTH) which together with vitamin D, regulates and maintains blood calcium at a normal level.

Though we make an effort to identify and preserve these glands during thyroid gland removal, they can sometimes be removed along with the thyroid or their blood supply can get cut off. This can give rise to low blood calcium. When only one lobe of the thyroid is removed, there is usually no risk of this complication. But when a total thyroid gland removal is deemed necessary, this risk is increased.

In most cases, where the calcium level falls, manipulation of the parathyroid glands can result in bruising of the glands. This can cause temporary dysfunction; however, the level reverts to normal within a month.

If all four glands are damaged or inadvertently removed, you will need to take calcium and vitamin D tablets for life to maintain blood calcium levels.

How long will it take to recover after the operation?

Most people will need to take 1-2 weeks off after the surgery.

Are there special instructions you need to follow during your recovery?

You may shower the day after surgery. However, try to keep the neck area as dry as possible and pat dry after showering. The stitches will be removed in the office about a week and a half after surgery.

After the stitches are removed, the most important thing you can do to improve the appearance of your scar is to protect it with sunscreen that has a sun protection factor (SPF) of 30. You should do this for an entire year and massage good quality moisturizers around it.

Will you need any special medicines after the surgery?

Depending on the amount of thyroid tissue removed and the reason for your surgery, you may require thyroid hormone for life. In addition, if your parathyroids are damaged during the surgery or if all of them are removed, you will also need calcium and vitamin D tablets.

What happens after recovery?

I will see you in 2-3 weeks and will discuss the pathology report of the removed thyroid gland. If additional treatment such as more surgery of Radio-Iodine is required, I will discuss it with you.

Will you need a follow-up?

If you have thyroid cancer, I recommend life long follow-up to check for its recurrence.

Parotid operation

What is the parotid and what causes parotid lumps?

The parotid gland makes saliva; you have two parotid glands, one on each side, in front of your ears. You can read more about salivary gland tumors by following this link > salivary gland tumor.

Why would you need parotid surgery?

Although 80% of the lumps in the parotid gland are benign. In most cases, I recommend that they are removed since they generally continue to grow, become unattractive and are more difficult to remove with increasing size. If you have Pleomorphic adenoma, it carries a small risk of turning into cancer after many years. In addition, there is always some concern about the exact cause of the lump until it has been removed because other investigations (biopsy or scans) can be inaccurate.

What should you expect for parotidectomy operation?

A parotidectomy is the surgical removal of part or all of the parotid gland. The operation takes 3 to 4 hours and is performed under general anesthetic, which means that you will be asleep throughout. A skin cut will be made which runs from in front of your ear and down into your neck. This cut can be of different size and placement, dependent on your tumor and your age. Some are shown below. This incision heals very well, and the scar is likely to be minimal. After the operation, you will have a drain (plastic tube) through the skin to prevent any blood clot collecting under the skin. We usually remove this tube after 24-48 hours following which you can be discharged home.

Most patients are aware of numbness around the skin on the operated side of the face, for some weeks to months after the operation. Often, you can expect your ear lobe skin to be permanently numb.

You will need 1-2 weeks off from work.

How painful is the operation?

Most patients will experience mild discomfort after the operation that can be adequately controlled with Ibuprofen. Some patients find chewing painful after this operation. This usually settles down within a week. It is advisable to eat soft, easy to chew food during this period.

What are the possible complications of parotid operation?

Serious complications after parotid surgery are very rare but may include:

Facial weakness: There is a vital nerve, the facial nerve, which passes right through the parotid gland. This makes the muscles of the face move and if it is damaged during the surgery can lead to weakness of the face (facial palsy). In most cases, the nerve works as usual after the surgery. However, sometimes (in about 15-20% of cases), where the tumor has been very close to the nerve, a temporary weakness of the face can occur that can last for a few weeks.

In less than 1% of cases, there is a permanent weakness of the face following this sort of surgery for benign tumors. If you have cancer (not the benign tumor), this risk is much higher. In some cases, the nerve has to be deliberately cut if the cancer is too close or if the nerve is already not working before the operation. I will discuss this with you before the operation if that is the case.

Blood clot: A blood clot can collect beneath the skin (a hematoma). This occurs in about 5% of patients, and it is sometimes necessary to return to the operating theatre and remove the clot and replace the drain.

Salivary collection: In 2-5% of patients, the cut surface of the parotid gland leaks a little saliva, in which case this can also collect under the skin. If this happens, it is necessary to remove the saliva, usually just with a needle, like a blood test, although it may need to be repeated. Occasionally you may need BOTOX injection or rarely another operation to manage it.

Frey’s syndrome: Some patients find that after this surgery, their cheek can become red, flushed, and sweaty while eating. This is because the nerve supply to the parotid gland can regrow in the wrong direction to supply the sweat glands of the overlying skin, instead of the parotid. This can usually be treated easily by the application of a roll-on antiperspirant. If this does not work, you may need BOTOX injection or rarely another operation to manage it.

Will the tumour come back?

There is a small risk of the tumor coming back (1 in every 200 to 300 patients). This risk is much higher if you are having a revision operation.

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“Mr. Supriya operated on my daughter Mia earlier this year carrying out a septoplasty and surgery to both turbinates. I am a nurse myself and have worked for many years in the operating theatre and cosmetic industry so I am used to dealing with surgeons. Mr Supriya is an amazing person, not only a very competent surgeon but a very kind caring man who put himself out completely to help and accommodate Mia for her surgery. For the first time in 12 years Mia can breath properly so to say we are grateful is an understatement.”

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“I was there for my medical examination. From setting up appointments, registration, consultation and check up process, all staff and Mrinal himself were exceptional. I would highly recommend the clinic and I am very happy with the results of my treatment.”

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“The result from my surgery was fantastic – it was exactly what I wanted. I had an open septorhinoplasty, and as soon as I came out of surgery I could breath much better than before. To my surprise, I didn’t experience any noticeable facial bruising or swelling at any point in my recovery.”

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“The results were so natural-looking that no one at work could tell I had anything done! I am delighted with my experience overall, and would certainly recommend Dr Supriya to anyone interested in cosmetic surgery, particularly rhinoplasty.”

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“My experience has been amazing from the first consultation till the surgery and even after the surgery. The support and care given by Steve (Patient Coordinator) and my surgeon Dr Mrinal Supriya has been amazing and comforting. I am very pleased with the results so far and I couldn’t be happier.”

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A government website that gives a great amount of information on the cancer and treatment. Click here for more information.

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About the expert

Mr Mrinal Supriya | Facial Cosmetic Surgeon

FRCS (OTOL-HNS), MRCS Ed, DO-HNS, MS in ENT, MBBS

Mr Mrinal Supriya is a Consultant ENT Head and Neck Surgeon with a special interest in facial cosmetic surgery. Mr Surpriya has previously worked in top hospitals around the world including some in the UK, Australia and USA. He has also spent time with Dr Andrew Jacono at his New York clinic who has been named one of the top plastic surgeons in the USA. In the UK, Mr Supriya has worked as an ENT Consultant at Northampton General Hospital & St. George’s University Hospital, London as well as Ninewells University Hospital, Dundee.

Mr. Supriya’s clinical interests are minimal-access facial cosmetic procedures with a further expertise in Deep Plane Facelift and Rhinoplasty. By limiting his cosmetic practice only to the face, Mr Supriya has developed super-specialised skills and achieved extremely reliable results with high patient satisfaction. By focusing entirely on facial cosmetic surgery procedures, Mr Supriya is able to provide comprehensive expertise that can only come from super specialisation: eyelid rejuvenation, nose job, endoscopic brow, face and neck lift, lip rejuvenation, cheek rejuvenation, ear surgery, chin surgery, Buccal fat pad resection and skin treatments.

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