Welcome to Dr John Chaplin Head and Neck Surgeon

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July 2019

Head and Neck Surgery- Auckland

Your Surgeon

Dr John Chaplin is an experienced,  high volume head and neck surgeon with  an international pedigree and reputation. John is an expert in the management of thyroid nodules and particularly thyroid cancer including thyroid cancer that has metastasised to neck lymph nodes. John also has expertise in diagnosing and managing salivary gland tumours and swellings . He is highly skilled in managing the facial nerve in parotid tumours and particularly in cancers involving the parotid gland. John has just completed co-authoring a book chapter on the management of metastatic and advanced cutaneous malignancy to the parotid gland that is due for publication in late 2019. He is a surgical leader in neck dissection  and performs neck dissection procedures weekly for management tongue cancer, HPV and non HPV related throat cancer, larynx cancer and skin cancer that has metastasised to neck lymph nodes. Dr John Chaplin has 20+ years experience in private and public hospital in head and neck surgery and is an integral member of the Auckland Regional Head and Neck Team. John has trained over 20 international fellows in head and neck surgery and microvascular reconstruction and he  is the highest volume head and neck reconstructive surgeon in the country. John can see patients with neck lumps urgently. Call (09) 6311948 or click this link

 

One Stop Neck Lump Clinic

John Chaplin performs neck lymph node  and neck lump investigations with office based ultrasound scan and fine needle aspiration (FNA) biopsy at his One Stop Neck Lump Clinic based at Mauranui Clinic in Epsom, Auckland.

Examination and Endoscopy

At these appointments a full expert head and neck examination is performed and this includes flexible endoscopy of the upper airway. This allows a comprehensive assessment of potential tumour primary sites that may lead to neck lumps. This is particularly relevant in the current HPV related oropharyngeal cancer era, where it is recognised that there is an increase in HPV related tonsil and base of tongue throat cancer that goes against the decline in other cancers seen.

Neck and Thyroid Ultrasound

Ultrasound is performed at the time and the site,  number and size of the lump or lumps is noted. In addition, the echogenicity, shape, margin, vascularity and calcifications are reported upon. These  features are compared against risk based scoring systems particularly with respect to thyroid nodules to determine whether FNA biopsy is indicated.

Neck Lump FNA Biopsy

If FNA is indicated it will be performed under ultrasound guidance as this allows accurate placement of the needle into the tissue likely to offer the highest yield of cellular material and therefore a diagnosis. The material is processed urgently and an accurate answer is available within 24-48 hours. A follow up appointment will be arranged to discuss the results.

CT Scanning

CT scanning is available on site at Mauranui Clinic with Ascot@Mauranui scanning allowing full contrast enhanced scanning appropriate for assessment of primary site and regional nodal assessment as well as assessment of distant sites like lungs.

Services offered at our “One Stop Neck Lump Clinic.”

Mauranui Clinic 86 Gt South Road Epsom

Urgent appointments available here

Specialist assessment.

At our Neck Lump Clinic you will  not be assessed by  a recently qualified, recently trained surgeon who has a limited degree of experience. You will be seen by Dr John Chaplin, a highly experienced head and neck surgeon who is trained to recognise the nuances of neck lump presentation.  Examinations are thorough and once investigations are performed, at the same appointment setting, it is usual for an experienced surgeon to have a working diagnosis in a very short time.

The treating surgeon  can then usually give you a very accurate outline of what further investigation and treatment would involve. The level of high volume surgery and vast experience of the specialist makes this a far more comprehensive interaction than may be available elsewhere. The patient will benefit from:

 

Office Based Neck Ultrasound Examination

Any patient who attends our One Stop Neck Lump Clinic will undergo an office based ultrasound scan using a General Electric Logiq E scanner that, despite being a small machine, has fantastic resolution and produces some of the best images I have seen. Many years of looking at ultrasound images of neck lumps every day along with the insight that may years of performing complex open neck surgery has given me unparalleled intuition as to what might be significant or not. I am not necessarily influenced by radiology or pathology opinions that come from personnel that spread there skills among other anatomical and pathological areas as those who work for other neck lump clinic services may be.

 

Fine Needle Aspiration Biopsy (FNA)

A safe and accurate technique to investigate all lumps in the neck including nodules in the thyroid gland tumours in the salivary glands and all pathology in neck lymph nodes. A fine needle is passed into the neck lump under ultrasound guidance to ensure accurate placement into the tissue most likely to yield diagnostic material. The needle in then massaged in and out of the neck lump to milk cells up into the needle shaft. The cells are then either smeared onto a glass slide and sprayed with fixative or washed into cell preserving solution and sent to the lab. Usually the results are available in 24-48 hours and Dr Chaplin will contact you with this results.

CT scanning

Full contrast enhanced CT scanning is available onsite at Mauranui Clinic, 86 Great South Road Epsom Auckland. Where appropriate a scan will be arranged at the time of the original appointment reducing the inconvenience of another  appointment and speeding up the diagnostic process significantly.

 

Urgent Neck Lump Appointments Available

Call  096311948

 

When Should I See A Neck Lump Specialist?

All lumps in the neck must have a diagnosis! A specialist review at our One Stop Neck Lump Clinic at 86 Mauranui Clinic in Epsom, Auckland will allow a diagnosis and management plan in the earliest possible time. Call Auckland 09 6311948 for or click on this link for an urgent appointment

Neck Lumps occur at different ages and in different areas of the neck and these factors can help lead to an early diagnosis. In younger adults and children lumps in the neck are usually either inflammatory or congenital in origin whereas in older adults a much higher index of suspicion for cancer must be maintained. The neck is divided into several regions: 1. Anterior neck; 2. Lateral neck; 3. Posterior neck; 4. Angle of the jaw; 5. Submandibular region. The anterior  neck is divided at the level of the hyoid bone into a. suprahyoid and b. infra hyoid regions. The lateral neck is further divided into a. The carotid sheath and b. The posterior triangle.

Posterior Neck Lumps

The posterior neck contains very few structures of importance and skin cancer metastasising to occipital and post auricular lymph nodes are the only significant malignancies that present in this region. Other lumps include lipomas and benign lymph node swellings.

Anterior Neck Lumps

Infrahyoid masses will be mostly thyroid in origin see Thyroid Surgery. Nearly all thyroglossal duct cysts are below the hyoid, slightly left of midline, and seen in young people. Pretracheal nodes that are caused by metastatic laryngeal or thyroid tumours can also present in this region . Suprahyoid masses may be thyroglossal but are more likely to be submental lymph nodes involved by inflammation or malignancy from the skin or oral cavity, particularly the floor of mouth. Dermoids are rare developmental inclusion cysts that form in the midline during embryonic development but often do not manifest until later in life. Thyroid tissue can arrest anywhere along the thyroglossal tract and can present in the submental region.

Lateral Neck Lumps

Lateral neck masses are more complex. They most commonly present in the carotid sheath in association with the carotid artery or jugular vein but they can also appear in the posterior triangle.
Solid lesions in the lateral neck are either nodal (inflammatory or metastatic malignancy) or they are rare tumours like carotid body tumours, neurogenic tumours associated with many of the nerves in the neck or rarely they can be malignant sarcomas of the deep neck tissues. Cystic lesions may be congenital branchial cleft cysts or lymphatic/vascular malformations. However they may also be cystic malignant nodes. These are notoriously difficult to diagnose and needle biopsies are often non- diagnostic.
Cystic nodal metastases are frequently confused with benign branchial cleft cysts and a careful history of upper aerodigestive tract symptoms is important to elicit.particularly in the era of HPV related Oropharyngeal cancer. Thyroid cancers may also appear as cystic lymph nodes in the lateral neck
Lesions in the skin and subcutaneous tissues are usually benign but skin cancers and melanoma can occur as cutaneous nodules.
Nodal lesions in the posterior triangle and supraclavicular area are less common. Metastases to this area either come from skin lesions in the posterior scalp or  from nasopharyngeal carcinoma, most frequently seen in Asian patients. Typically TB can affect lymph nodes in this area. Atypical TB in children tends to affect level I nodes in the submandibular area.

Submandibular Neck Lumps

Lumps in the submandibular area are usually related to the submandibular gland. Obstruction of the duct by stones or sludge typically presents as painful swelling associated with eating or even with the thought of food. The swelling will generally resolve over a period unless an ascending infection develops. Sometimes the stone can be felt in the duct in the floor of the mouth. Massaging the gland rather than producing a good flow of clear saliva often produces a small amount of turbid saliva or none at all. Submandibular salivary tumours present as painless progressive swellings. About 50% are malignant. See Salivary Gland Surgery.

Lymph node metastases to this area are either from lip or anterior facial skin cancers or from tumours on the oral tongue, floor of mouth or buccal mucosa.

Lumps at the Angle of the Jaw

Parotid swellings, that occur in the preauricular area, in the tail (which is often difficult to separate from the upper neck) or in the deep lobe, are usually neoplasms. Most tumours are benign but NZ has a high incidence of metastatic skin cancer to nodes in the parotid and our most common parotid malignancy is metastatic SCC. See Salivary Gland Surgery
Congenital cysts can occur in this region and they originate from the first branchial arch.

 

If you have concern regarding a neck lump call our One Stop Neck Lump Clinic on Auckland 09 6311948

 

 

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