Cancer involves an accumulation of genetic alterations that result in a stepwise progression toward unregulated growth and invasion. Understanding the evolution of a normal cell to its neoplastic state, including knowledge of the precipitating genetic defects, is vital to the development of potential treatments to combat unregulated growth. This review discusses the accession of specific critical properties underlying neoplastic transformation. Specifically, the cell cycle, the primary characteristics of cancer (continuous growth signaling, insensitivity to growth inhibition, evasion of apoptosis, angiogenic potential, immortalization, and invasion or metastasis), and cancer therapeutics are described. Figures show a simplified schematic of the cell cycle, cyclin-CdK complex function during the cell cycle, growth factor binding receptors, the mechanism of oncogene production, various transmembrane tyrosine kinases, the translocation of Ig heavy and light chains to the Myc locus on chromosome 8 in Burkitt lymphoma, a translocation observed in chronic myelogenous leukemia, the INK4A locus, and the apoptotic pathway. Tables include nonexhaustive lists of oncogenes in human malignancies and selected tumor suppressor genes associated with inherited susceptibility.

This review contains 9 figures, 5 tables, and 186 references

Keywords: Cancer, carcinoma, molecular biology, cell cycle, chromosomal aberration, tumor suppressor gene, proto-oncogene, oncogene, malignancy, angiogenesis, apoptosis, immortalization

The thyroid plays a key role in normal metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and modulation of adrenergic regulation. Surgical consultations are most often requested for control of hyperthyroidism or for treatment of euthyroid nodular disease. This review describes the approach to the patient with hyperthyroidism and with euthyroid nodular disease, including papillary, follicular, anaplastic, medullary, and primary thyroid cancer, and oncocytic (Hürthle cell) carcinoma. Operative techniques of thyroidectomy are described and include positioning, incisions-making, and troubleshooting. Postoperative care, including thyroid hormone management, is described. Complications and outcome evaluation are discussed. Tables list the etiologies of hyperthyroidism, benign and malignant etiologies of euthyroid nodular disease, familial syndromes of thyroid disease, the Bethesda classification of fine needle aspiration cytology and associated malignancy risk, the elements of common prognostic schemes for well-differentiated thyroid cancer, and the staging of differentiated, medullary, and anaplastic thyroid cancer. Figures show the six levels of cervical lymph nodes, the initial incision in a thyroidectomy, a midline incision, the superior pole vessels, the upper and lower parathyroid glands, the recurrent laryngeal nerve, and Delphian lymph nodes. An algorithm shows the approach to the patient with thyroid disease

This review contains 7 figures, 25 tables, and 70 references

Keywords: Hyperthyroidism, Graves disease, goiter, toxic nodular, solitary toxic nodule, thyroid cancer, radioactive iodine, Bethesda classification

Approximately 5% of all cases of trauma involve injury to the neck. This relatively low incidence together with improvements in diagnostic modalities has led to continuing evolution in the management of neck trauma. Injuries to the neck can be the result of blunt and penetrating trauma. Both mechanisms can cause devastating injuries, with high associated morbidity and mortality. This review examines the airway, penetrating neck trauma, and blunt trauma. Figures show an algorithm outlining operative management of known or suspected injuries to the carotid arteries, jugular veins, pharynx, and esophagus, a tracheotomy hook used to retract the thyroid cartilage cephalad to facilitate placing the airway, the traditional division of the neck into three separate zones, exposure of structures in the anterior areas of the neck through an incision oriented along the anterior border of the sternocleidomastoid muscle, dissection of the sternocleidomastoid muscle carried down to the level of the carotid sheath, a balloon embolectomy catheter used to occlude the distal internal carotid artery at the skull base, a number of important structures encountered during distal dissection of the internal and external carotid arteries, options for repair of the arteries in the neck, exposure of the vertebral artery and the vertebral veins surrounded by the transverse processes of the cervical vertebrae, exposure of the distal vertebral artery via an incision along the anterior border of the sternocleidomastoid muscle, control of bleeding from vertebral artery injuries located within the transverse process of the cervical, approaching proximal vertebral artery via a supraclavicular incision, and an algorithm outlining management of known injuries to the vertebral artery, which are most often discovered by angiography. The table lists screening criteria for blunt cerebrovascular injury.

This review contains 14 figures, 4 tables, and 45 references

Keywords: Neck injury, aneurysm, carotid dissection, blunt trauma, penetrating trauma, tracheotomy, endovascular repair

Foreign-body ingestion and food bolus impaction are common causes of esophageal obstruction, with an annual incidence of 13 cases per 100,000, and represent approximately 4% of all emergency endoscopies. Although the majority of foreign bodies that travel to the gastrointestinal (GI) tract will pass spontaneously, 10 to 20% must be removed endoscopically, and 1 to 5% will require surgery. Key diagnostic and therapeutic decisions are based on common factors, including the type of ingested object, number of objects, timing between ingestion and presentation, anatomic location of the object, and presence or absence of symptoms. Complications relating to foreign-body ingestion are typically uncommon; however, the associated morbidity may be severe and occasionally life threatening, and despite the fact that overall mortality has been extremely low, it has been estimated that up to 1,500 deaths occur annually in the United States as a result of foreign-body ingestion. The initial and follow-up management strategies are crucial to preventing morbidity. This review details the epidemiology, etiology and pathophysiology, diagnosis, management, and complications of foreign-body ingestion. Figures show examples of foreign bodies in the esophagus and stomach, three esophageal areas where a foreign body is likely to be impacted, examples of a meat bolus in the esophagus, radiograph of a patient who swallowed one nail and three batteries, and examples of linear erosions of the esophagus and stomach. Tables list the most common GI pathology predisposing individuals to esophageal foreign-body impaction, timing and management of food bolus impaction and foreign-body ingestion, endoscopic management strategies for food bolus impaction and ingested foreign bodies, and radiographic and surgical management strategies for monitoring progress of foreign-body passage through the GI tract.

This review contains 5 figures, 9 tables, and 81 references.

Keywords: Emergency department, endoscopy, foreign body, foreign body ingestion, pediatrics, gastroenterology, impaction, gastrointestinal obstruction

Large bodies of evidence link alcohol consumption and substance use disorders (SUDs) with motor vehicle collisions, as well as life-threatening intentional injury.  According to the substance use and mental health estimates from the 2013 National Survey on Drug Use and Health, 24.6 million individuals age 12 or older were current illicit drug users in 2013, including 2.2 million adolescents age 12 to 17, and 60.1 million individuals age 12 or older were binge drinkers in the past month.  Many people with SUDs become patients; therefore, the surgeon must be able to recognize and manage many of the related issues that can ensue. This review details the definition of SUDs, basic principles of toxicology, acute management of the patient with suspected substance use intoxication or withdrawal, managing life-threatening syndromes in patients with SUDs, overdose and withdrawal syndromes of opioids, stimulants, and depressants, surgical complications of SUDs, perioperative and postoperative considerations in patients with SUDs, and consultation and referral to a toxicologist and poison control center. Figures show first- and zero-order kinetics;  pupillary examination, laboratory and radiographic findings in SUDs; polymorphic ventricular tachycardia; consciousness as an interplay between arousal and awareness, an algorithm for the management of seizures, sine, mechanism of cocaine’s cardiac toxicity and hemorrhagic stroke in a cocaine abuser, necrotizing soft tissue infection, digit necrosis associated with intra-arterial injection of cocaine, scars from skin popping, nonocclusive thrombus in the left internal jugular vein, needle fracture with soft tissue dislodgment, oral contrast-enhanced computed tomographic scan showing rounded foreign bodies in the stomach, and fecal impaction associated with heroin. Tables list criteria for substance use disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V), frequently misused drugs, causes of death in SUD, cardiac, neurologic, and metabolic signs and symptoms caused by commonly abused substances , anion and osmolar gap equations, life-threatening manifestations of cocaine toxicity, and alcohol-related disorders.

This review contains 15 figures, 8 tables, and 85 references.

This review presents normal wound healing as a complex process that is generally carried out in three overlapping stages: an inflammatory phase, a proliferative phrase (made up of fibroplasia, contraction, neovascularization, and granulation), and a remodeling phase. In addition, wound healing occurs under the influence of multiple cytokines, growth factors, and extracellular matrix signals. Figures show the layers of the skin and the cycles of wound healing. 

This review contains 6 figures, 8 tables, and 47 references

Keywords: wound, wound care, healing, epithelialization, migration, granulation

Major salivary gland tumors constitute 3 to 6% of all tumors of the head and neck in adults, and about 85% of these salivary gland tumors are found in the parotid gland. Approximately 70% of parotid lesions are neoplastic, and roughly 16% of these neoplasms are malignant. The spectrum of histopathologic entities encompassed by the term parotid mass is exceedingly broad and continues to evolve as our understanding of the origin and clinical behavior of the various tumors arising from the parotid gland expands. This review discusses the anatomy, etiology, differential diagnosis, diagnostic workup and imaging, surgical management, and overall prognosis for parotid masses.

This review contains 6 figures, 11 tables, and 84 references.

Key words: facial nerve, fine-needle aspiration, imaging, malignant neoplasm, neck dissection, parotid mass, parotidectomy, pleomorphic adenoma 

and renal hyperparathyroidism, parathyroid carcinoma, and multiple endocrine neoplasia syndromes. A standard surgical method is bilateral neck exploration, which enables the examination of all parathyroid tissue. A focused parathyroidectomy can also be considered when preoperative imaging tests (ultrasonography/sestamibi scanning/four-dimensional computed tomography) are concordant. This review discusses diseases of the thyroid glands, evaluation of primary hyperparathyroidism, treatment, operative planning, the operative technique for bilateral neck exploration and an alternative operative technique for focused parathyroidectomy, special concerns, postoperative care, and complications. 

This review contains 6 figures, 7 tables, and 33 references.

Keywords:Parathyroid hormone, hypercalcemia, resection, recurrent laryngeal nerve monitoring, hyperparathyroidism, operative technique

The evaluation of any neck mass begins with a careful, directed history focused on an appropriate differential diagnosis. Directed questions can narrow the diagnostic possibilities and focus subsequent investigations. For example, in younger patients, one might have an initial suspicion of congenital or inflammatory lesions, whereas in older adults, the primary concern is often neoplasia. The head and neck examination is challenging because much of the area to be examined is not easily seen. Patience and practice are necessary to master the special instruments and techniques of examination. Most neck masses in adults are abnormal and are often manifestations of underlying conditions that require treatment. In most cases, therefore, further diagnostic evaluation should be pursued. This review covers clinical evaluation, developing a differential diagnosis, investigative studies, and management of specific disorders associated with neck mass. Figures show cervical lymph nodes, a management algorithm for thyroid nodules, and the course of the thyroglossal duct from the foramen cecum to the pyramidal lobe of the thyroid gland. Tables list the etiology of neck mass, classification of cervical lymph nodes, and sonographic findings and size indications of biopsy of thyroid nodules.

This review contains 4 figures, 9 tables, and 8 references.

Key words: cervical adenopathy; cervical lymph nodes; congenital neck mass; enlarged lymph nodes; fine-needle aspiration; neck mass; thyroid disease; thyroid mass; thyroid nodule

In the adult, the thyroid gland is located in the central compartment of the neck on the anterolateral aspect of the cervical trachea between the carotid sheaths. Patients with thyroid disorders require attentive care, and safe, successful surgery of the thyroid is dependent on an intimate knowledge of the anatomy and physiology of the gland. This review discusses nerve branches and function; arterial and venous blood supply; lymphatic drainage; histology; physiology; and thyroid hormone synthesis, secretion, and regulation. Nerve injuries and postoperative complications are summarized, as are functions of thyroid hormones. A thorough understanding of these relationships is imperative for proper medical recommendations, surgical procedure selection, and meticulous surgical technique to avoid complications. To provide safe care of patients with thyroid disorders, treating physicians must embrace the intricate details of the anatomy and physiology of this unique gland to avoid potentially devastating complications.

When a patient presents with a mass at the angle of the mandible, a neoplasm within the parotid gland is a strong consideration. The parotid is the largest of the salivary glands. Terminal branches of the facial nerve are found within the gland. Their functional preservation is an important goal of parotid surgery. Risks of facial nerve injury rise in reoperative procedures and resection of cancers. Surgical principles apply in parotidectomy. In addition to facial nerve injury, a numb earlobe, contour deficit, salivary fistula, and gustatory sweating should be discussed with the patient before an operation. Most lesions can be removed after identification of the main trunk of the facial nerve, but a retrograde approach after finding a peripheral branch may be required. No randomized trials support a benefit from nerve monitoring. An intact facial nerve will usually begin to function, but months of recovery time may be needed. Permanent paralysis is rare. Salivary fistulae are usually self-limited. Many methods to ameliorate the cosmetic changes after parotidectomy have been described. None has gained ascendency.

This review contains 6 figures and 61 references.

Key words: facial nerve, facial paralysis, Frey syndrome, gustatory sweating, nerve monitoring, parotid gland, parotid neoplasm, parotidectomy, salivary fistula 

The thyroid is key to numerous metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and adrenergic regulation. A normal thyroid gland weighs 15 to 25 g and is firm, mobile, and smooth to palpation. There are two distinct physiologically active cell types: follicular cells, which synthesize thyroid hormone, and parafollicular or C cells, which produce calcitonin. Surgery is indicated for three broad categories of thyroid disease: (1) a hyperfunctioning gland, (2) an enlarged gland (goiter) causing compressive symptoms, and (3) diagnosing or treating malignancy. These indications may overlap in a patient presenting for surgical consultation. Regardless of the indication, a thorough discussion with the patient about the thyroid disease and other diagnostic or therapeutic options (if any) should be conducted.

This reviews contains 3 figures, 13 tables, and 56 references.

Key Words: anaplastic thyroid cancer, antithyroid medications, Bethesda classification, follicular thyroid cancer, Graves disease, medullary thyroid cancer, nontoxic multinodular goiter, papillary thyroid cancer, radioactive iodine, toxic nodular goiter

Historically, thyroidectomy was associated with a high mortality rate, now understood to likely be secondary to postoperative hypocalcemia. In the modern age, perioperative morbidity and mortality rates are extremely low, although some complications, such as recurrent laryngeal nerve injury, can have significant consequences. Understanding the safe approach to total thyroidectomy and thyroid lobectomy is key to minimizing operative morbidity. In particular, the capsular dissection technique facilitates identification and preservation of the recurrent laryngeal nerve and parathyroid glands. The postoperative care of the patient, including diagnosis and management of the more common complications such as hematoma or hypocalcemia, is crucial to optimize patient outcomes. Although novel thyroidectomy techniques have been developed to avoid or minimize the traditional neck incision, these approaches have not become widely used.

This review contains 9 figures, 1 table, and 29 references.

 Key Words: capsular dissection, external branch of the superior laryngeal nerve, intraoperative nerve monitoring, minimally invasive thyroidectomy, postoperative hematoma, postoperative hoarseness, postoperative hypocalcemia, recurrent laryngeal nerve, remote access thyroidectomy

The surgical management of lesions of the oral cavity is complex and requires the surgeon to consider multiple factors. Frequently a multidisciplinary team should be included in the decision-making process, particularly when a malignant lesion is being treated. Preoperative evaluation is critical in determining the optimal therapy and often will include radiologic evaluation and flexible endoscopy in addition to physical examination. Surgical decision making includes determining when a transoral approach is possible and appropriate versus a more extensive surgical approach such as a lip split and mandibulotomy. For small lesions, with a cooperative patient, local anesthesia might be adequate, but often, general anesthesia will be required. For malignant lesions, management of possible cervical node metastasis must be included in the treatment plan. Management of the airway during surgery and postoperatively must also be carefully considered. When there is concern for significant postoperative swelling or trismus, which might make reintubation difficult, tracheostomy should be considered. Primary closure can be effective for small defects. In some circumstances, a skin graft or local flaps can be successfully employed. When surgical excision results in larger defects, reconstruction must be included in the surgical plan.

This review contains 13 figures, 7 tables and 32 references

Key Words: glossectomy, lip split, oral cancer, mandibulectomy, mandibulotomy, maxillectomy, ranula, sialendoscopy

It is expected that surgeons have detailed and nuanced knowledge of the procedures they perform. It is equally necessary that surgeons have a working knowledge of anesthesia because it is important in patient selection for surgery, and for intraoperative factors including patient positioning and invasive monitoring. Proper care of the operative patient requires excellent communication and coordination between the surgical and anesthetic team. Providing optimal perioperative care for the patient requires the surgeon to understand the risks and benefits of each anesthetic approach and to relay potential portions of the procedure that may have a profound impact on the patient’s physiology so the anesthesiologist can properly prepare for it. With the increasing complexity of patients and the operations being performed, this ensures the best possible outcome.

This review contains 6 figures, 13 tables, and 142 references

Keywords: Local anesthetic, regional anesthesia, general anesthesia, sedation, cardiovascular risks, preoperative evaluation, difficult airway, perioperative medications, surgical risk calculators

Successful surgery of the parathyroid glands depends on a thorough knowledge of their anatomic and developmental relations. This knowledge is crucial for locating ectopic parathyroids or preventing injury to the recurrent laryngeal nerve. In addition, the surgeon should understand the physiology and function of these glands. Unlike other conditions a surgeon might treat, physiology, and not anatomy alone, often dictates the timing and course of parathyroid procedures. This surgeon-oriented, focused review covers the development, histology, anatomy, physiology, and pathophysiology of the parathyroid. Figures show the location and frequencies of ectopic upper and lower parathyroid glands, and regulation of calcium homeostasis.

This review contains 2 highly rendered figures, and 16 references

Key words: calcitonin; hypercalcemia; hyperparathyroidism; multiple endocrine neoplasia; parathyroid; parathyroid hormone; primary hyperparathyroidism; secondary hyperparathyroidism; tertiary hyperparathyroidism

With an estimated 232,670 new cases in the United States in 2014, breast cancer is among the most common malignancies treated by US surgeons. Meanwhile, the incidence of melanoma is rising faster than for all other solid malignancies, with an estimated 76,100 new cases of invasive melanoma in the United States in 2014. Over the past 20 years, significant strides have been made in the management of these two diseases from the standpoint of both surgical and adjuvant therapy. For both diseases, the presence or absence of lymph node metastases is highly predictive of patient outcome and is the most important prognostic factor for disease recurrence and cancer-related mortality. This review covers lymphatic mapping and sentinel node biopsy for melanoma, special circumstances associated with sentinel node biopsy in melanoma, lymphatic mapping and sentinel node biopsy in breast cancer, and radiation exposure guidelines and policies. The figures show lymphatic mapping and sentinel lymph node biopsy for melanoma, lymphatic mapping and sentinel node biopsy for breast cancer, and touch-imprint cytology from lymphatic mapping and sentinel node biopsy for breast cancer.

This review contains 3 figures, 4 tables and 91 references

Keywords: sentinel node, dissection, biopsy, breast cancer, melanoma, cancer, lymphatic mapping

The prevalence of malignant skin cancers has increased significantly over the past several years. Approximately 1.2 million cases of non-melanoma skin cancer are diagnosed per year. More alarming, up to 80,000 cases of melanoma are diagnosed per year, an incidence that has been steadily increasing, with a lifetime risk of 1 in 50 for the development of melanoma. The disturbing increase in the incidence of both non-melanoma skin cancer and melanoma can largely be attributed to the social attitude toward sun exposure. The clinical assessment and management of skin lesions can be challenging. This review describes the assessment process, including thorough history and examination; the need for possible biopsy; and excision criteria. Specific types of skin cancer are distinguished and include basal cell carcinoma; squamous cell carcinoma; and melanoma; and for each type the incidence; epidemiology; histologic subtypes; diagnosis; and both surgical and non-surgical treatments are provided. Stages I-IV of melanoma are detailed, with prognostic factors described. Surgical treatment for stages I and II include description of the margins of excision and sentinel lymph node biopsy. The surgical treatment of Stage III melanoma further includes therapeutic lymph node dissection and isolated limb perfusion. Adjuvant therapies are also presented and include radiotherapy and chemotherapy. The additional treatment of metastasectomy for Stage IV melanoma is described. For both Stage III and IV melanoma, the study of vaccines to host immune cells is reported. For Stage IV melanoma, the text also describes immunotherapy treatment. Operative procedures specific to superficial and deep groin dissections are outlined.

This review contains 9 figures, 19 tables, and 99 references

Need for neck dissection begins with thorough evaluation, including fine needle aspiration and possibly excisional lymph node biopsy. The incidence of the various neck metastases are provided, including those for cutaneous squamous cell carcinoma; salivary gland neoplasms; cervical lymph node metastases; squamous cell carcinoma of the upper aerodigestive tract; and metastatic well-differentiated thyroid cancer. Staging of neck cancer is also defined. Indications and contraindications for neck dissection are provided. Operative planning begins with the decision on the choice of procedure: a comprehensive dissection that will result in a radical or modified neck dissection; a selective neck dissection; an extended neck dissection; or a bilateral neck dissection. Neck dissection after chemoradiation is also discussed. Reconstruction after resection of large tumors with large margins is also described, along with current evidence relating to preservation of vascular structures and subsequent predisposition to recurrence. The operative steps for radical, modified, and selective neck dissection are described. Both intraoperative and postoperation complications are explained.

This review contains 5 figures, 9 tables, and 53 references

Keywords: Neck dissection, cervical adenopathy, lymphoma, head and neck cancer

Head and neck diseases can be inflammatory, infectious, congenital, neoplastic, or traumatic. The anatomy of the head and neck structures are described and include the ear, nose and paranasal sinuses (including the oral cavity, salivary glands, and pharynx), the larynx (including the supraglottis, glottis, and subglottis), and the neck. An accurate diagnosis is mandatory and is based on a detailed history and physical examination. Examination of the nose may be done with anterior or posterior rhinoscopy or rigid nasal endoscopy. The larynx and pharynx may be viewed by indirect, flexible, or direct laryngoscopy. Flexible or rigid esophagoscopy permits examination of the esophagus. The trachea and lungs are examined using rigid or flexible bronchoscopy, panendoscopy, or core or open biopsy. Imaging can include ultrasononography, barium swallow, computed tomography scans, positron emission tomography scans, and magnetic resonance imaging. Nearly one dozen figures show various anatomic structures and office equipment, including nasal specula, a laryngeal mirror, an esophagoscope, and a bronchoscope. Several recommended readings are provided.