At the Institute, Dr. Osborne and Dr. Hamilton perform all of your surgeries, meaning that a head and neck oncologist performs your tumor removal and a facial plastic surgeon performs your wound closure and reconstruction. No residents, physician assistants, or medical students perform any part of your procedure, which is commonplace at many teaching hospitals and universities.
Removal of a parotid tumor requires removal of a margin of normal tissue around the tumor as well to prevent regrowth. Unfortunately, this results in an increase in the volume of tissue removed from the face, leaving a “sunken” appearance. The bipedicled SCM muscle flap was designed to fill in the facial defect left by the tumor removal, restore facial symmetry, and maintain facial fullness.
Accessory parotid gland tumors are located in difficult to reach areas of the face. Typically, long facial incisions are used to gain access. This approach leaves scarring and facial contour deformities. The trans-oral approach eliminates all facial incisions, resulting in no scars. In addition, the trans-oral approach dramatically reduces the duration of surgery.
The facial nerve is only a few millimeters wide and is the most important structure to identify when performing parotid surgery. Incisions that extend up to the hair line and far down into the neck do nothing to improve exposure of the nerve. Long incisions simply add increased swelling, cause slower healing, and increase the risk of scarring. We perform a safer surgery through a smaller incision.
Unfortunately, some parotid tumors regrow after initial treatment, requiring further surgery. Repeat surgery increases both the chances of facial paralysis and facial cosmetic deformities. We specialize in removing recurrent tumors while maintaining facial nerve function and facial symmetry.
Parotid gland swelling and inflammation secondary to salivary stones can now be treated with minimally invasive techniques. The standard treatment for obstructive salivary gland stones is a total parotidectomy. Sialendoscopy allows these obstructive stones, which are causing the gland to be swollen, to be removed non-surgically, avoiding the standard risk associated with parotidectomy such as facial nerve paralysis and facial deformity.
Patients with benign tumors may be candidates for facial rejuvenation procedures in combination with their parotid surgery. Standard parotid surgery often leaves patients with facial irregularities secondary to skin expansion and stretching caused by the growing tumor. After tumor removal, the soft tissues of the cheek and overlying skin may be sagging, lax, and redundant,and may require sculpting to successfully reconstruct this facial area. This laxity may be more pronounced in aging women and men, or patients with larger tumors. To improve overall harmony to the face, it may be beneficial for some patients to combine other rejuvenation procedures with their primary surgery to comprehensively enhance their facial appearance. Dr. Hamilton has dual training in head and neck surgery as well as facial plastic and reconstructive surgery, making it possible, when appropriate, to restore form and function while simultaneously improving one’s appearance.
Frey’s Syndrome is a syndrome that includes sweating while eating (gustatory sweating) and facial flushing. It is caused by injury to a nerve, called the auriculotemporal nerve, typically after surgical trauma to the parotid gland. This nerve, when it heals, reattaches to sweat glands instead of the original salivary gland (which had been removed during surgery). The only cure is surgical correction. Frey’s can be prevented by reconstructing the parotid gland after parotidectomy.
Advances in facial augmentation with temporary and semi-permanent soft tissue fillers make it possible to improve the appearance of unsightly scars and facial asymmetries without the need for permanent implants or surgery. Candidates for these treatments generally have good facial symmetry with only minor scarring or facial deformities. Patients who have had multiple surgeries and desire less invasive procedures to improve their appearance may also find these treatments appealing. These procedures are performed on an outpatient basis and require little to no down time.
The American Laryngological, Rhinological and Otological Society, Inc., aka The Triological Society, was founded in 1895 in New York, New York. In the more than 100 years since its founding, the Triological Society has attracted the best and brightest in academic and clinical otolaryngology. Membership in the Triological Society brings the distinction of being elected to the most prestigious society in otolaryngology. Active Fellowship is achieved by presenting a thesis in the field of otolaryngology considered acceptable to a panel of peers. For those entering the field of otolaryngology, the Society provides role models. For those who are committed to research and related scholarly activity, the Society offers fellowship with like-minded peers who share common values, interests, and concerns.
The Society disseminates scientific information by presenting the latest basic science and clinical information at scientific meetings and through publication of its scientific journal, The Laryngoscope. The Society promotes research into the causes of and treatments for otolaryngic diseases by attracting promising physicians to scholarly otolaryngology research and supporting their development, providing financial support for the research efforts of young scientists, and promoting the highest standards in the field of otolaryngology-head and neck surgery.
All head and neck/ facial plastic surgeons are physicians who have undergone many years of education and training including college and medical school. After 20 years of education the physician applies for a “residency” in a particular subject. A “resident” is a licensed physician who is pursuing further post-graduate training after receiving a doctor’s degree from medical school.
Most head and neck/ facial plastic surgeons do their residency training in Otolaryngology-Head-and-Neck Surgery.
Such residents have succeeded in a very competitive and selective process. Most come from the upper 25% of their medical school class. Residency begins with one to two years of general surgical training. The resident then begins specialty training in Otolaryngology-Head-and-Neck Surgery, which lasts 5 to 6 years.
In the Otolaryngology-Head and Neck Surgery residency, the physician studies anatomy, physiology, illness and surgical treatment for head and neck.
After completing that residency, the surgeon then sits for the two-day certification examination in the specialty of Otolaryngology-Head-and-Neck Surgery. If the surgeon passed that examination, the surgeon becomes ‘board certified’ in Otolaryngology. For those surgeons who seek a higher level of mastery and expertise within a particular area of their subspecialty they may go on to complete a fellowship. Fellowships in Head and Neck Surgery include the subspecialties of Head and Neck Surgical Oncology (Dr. Osborne)and Facial Plastic and Reconstructive Surgery (Dr. Hamilton), among others. These fellowships are not simply extensions of the resident training, they are completely separate entities which lead to their own individual certification. General Otolaryngologists who say they are comfortable performing surgical oncology and facial plastics procedures do not possess the equivalent training nor expertise to perform these procedures.
Medical specialty certification in the United States is a voluntary process. While medical licensure sets the minimum competency requirements to diagnose and treat patients, it is not specialty specific. Board certification—and the Gold Star—demonstrate a physician’s exceptional expertise in a particular specialty and/or subspecialty of medical practice.
The Gold Star signals a board certified physician’s commitment and expertise in consistently achieving superior clinical outcomes in a responsive, patient-focused setting. Patients, physicians, healthcare providers, insurers and quality organizations look for the Gold Star as the best measure of a physician’s knowledge, experience and skills to provide quality healthcare within a given specialty.
Certification by an ABMS Member Board involves a rigorous process of testing and peer evaluation that is designed and administered by specialists in the specific area of medicine. Learn more about how a physician becomes board certified.
At one time, physicians were awarded certificates that were not time-limited and therefore did not have to be renewed. Later, a program of periodic re-certification (every six to 10 years) was initiated to ensure physicians engaged in continuing education and examination to keep current in their specialty.
In 2006, ABMS’ 24 Member Boards adopted a new gold standard for re-certification with a continuous ABMS Maintenance of Certification (MOC) program for all specialties. MOC uses evidence-based guidelines and national standards and best practices in combination with customized continuing education so physicians demonstrate their leadership in the national movement for healthcare quality. MOC also requires proof of continuing education and experience in between testing for re-certification.
Learn more about MOC. Consumers can also learn more about The Importance of Board Certification and verifying physician certification. Hospitals, healthcare organizations, insurers and other professional organizations can find out more about ABMS certification products and services.
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