Minimally Invasive Skull Base Surgery is a rapidly evolving field applying endoscopic technology to remove tumors in the head and neck, skull base, and intracranial compartment. We work to develop new approaches and new technology in this field; publish clinical experience and outcomes; develop and publicize a systematic approach to skull base lesions; and provide a consistent educational effort, including on-site courses, publications, and presentations at meetings and conferences.

The role MISB surgery is expanding in the management of benign and malignant tumors of the paranasal sinuses and skull base, providing access to the pituitary gland and certain intracranial lesions. MISB surgery uses an endoscope - a long, flexible instrument attached to a camera and a light source - to guide surgeons through very small ports of entry to remove these tumors. These procedures involve very small or no incisions, resulting in fewer complications, reduced blood loss, and shorter recovery times for patients.

Learn more about our Minimally Invasive Skull Base Surgery (pdf)

Please also visit the minimally invasive skull base surgery site, here.

Salivary Gland Surgery

Salivary Gland Neoplasms, Benign and Malignant

Salivary gland tumors and cancers are treated in conjunction with the UCSF Head and Neck Surgery Center and the UCSF Helen Diller Comprehensive Cancer Center. Salivary gland disorders include diseases affecting the parotid gland, submandibular gland, and minor salivary glands. Some common disorders of the salivary glands that are treated by our physicians include:

• Pleomorphic adenoma
• Warthin's tumor (papillary cystadenoma lymphomatosum)
• Oncocytoma
• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma
• Acinic cell carcinoma
• Adenocarcinoma
• Carcinoma ex-pleomorphic adenoma
• Squamous cell carcinoma
• Parapharyngeal Space Tumors
• Parotid Gland Cancer
• Parotid Gland Tumors
• Salivary Gland Disorders
• Salivary Gland Stones
• Salivary Gland Tumors
• Submandibular Gland Cancer
• Submandibular Gland Tumors
• Salivary gland disorders
• Salivary gland neoplasms

Sialendoscopy

As one of the first centers in the United States to pioneer sialendoscopy techniques, the UCSF Sialendoscopy Center is globally recognized as a leader in the development and advancement of this minimally invasive therapy. Prior to sialendoscopy, treatment for salivary gland obstruction due to stones was limited to surgical removal of the affected gland. Modern technology allowed for the development of extremely small endoscopes (size range: 0.8mm to 1.6mm). Drs. William Ryan and Jolie Chang have been trainsed to use this small endoscopic camera system to enter the salivary ducts through the mouth and examine the duct system for problems such as salivary duct stones (sialolithiasis) and scarring (stenosis). Our providers are able to use the sialendoscope to guide forceps and wire baskets to remove salivary stones and break up larger stones using a laser (lithotripsy). Sialendoscopy also allows for the application of medications for treatment of blocked salivary ducts. Often these treatments involve limited or no incisions in the mouth and can be an alternative to open surgery or salivary gland removal.

Our sialendoscopy experts train head and neck surgeons around the nation on cutting-edge sialendoscopic techniques and are actively engaged in advancing the field through innovation and research. Some of their studies have addressed:

• The combination of sialendoscopy with ultrasound imaging for diagnosis and therapies.
• Predicting which patients would benefit from sialendoscopic surgery.
• Following patients with stones and stenosis to study the benefits of sialendoscopy.
• Surgical techniques for accessing the salivary ducts.
• Pioneering new techniques to remove and break apart salivary stones.

Other Salivary Gland Conditions

Many processes may affect the salivary glands, from previous therapies to systemic illnesses. These can include:

• Recurrent salivary gland swelling or enlargement
• Radiation Therapy
• Radioactive Iodine
• Sjogren’s Syndrome
• Salivary gland infections, parotitis
• Trauma

Advanced Head and Neck Reconstruction

Our team includes Head and Neck reconstructive surgeons who are highly skilled to recreate both form and critical function of the head and neck. Advanced reconstruction techniques include local flaps, regional flaps, and microvascular free flaps.

Speech and Swallowing Rehabilitation

Dysphagia or difficulty swallowing is a common challenge shared amongst the head and neck cancer population. Comprehensive assessments are performed utilizing technologically advanced equipment, including Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Modified Barium Swallow Studies (MBSS). Individualized therapy programs to treat speech and/or swallowing disorders are provided by our specialized speech and swallowing therapists.

Head and Neck Research and Education

Our surgeons believe in the power and importance of research to improve treatments and education to train aspiring surgeons. They are actively involved in teaching and lecturing in the UCSF School of Medicine and the UCSF Otolaryngology-Head and Neck Surgery Residency-Training Program. They are among the directors and regular faculty participating in yearly courses attended by physicians from around the nation:

• The UCSF Head and Neck Cancer and Endocrine Surgery Update Course in San Francisco, CA
• The UCSF Sialoendoscopy/Salivary Duct Surgery Course in San Francisco, CA
• The UCSF Skull Base Dissection Course in San Francisco, CA
• The UCSF Otolaryngology-Head and Neck Surgery Update Course in San Francisco, CA
• The UCSF/Tripler Pacific Rim Otolaryngology-Head and Neck Surgery Update Course in Honolulu, HI

With the advent of new technology to aid in operative approaches, to the development of novel treatment medications and diagnostics, to the nuanced design of innovative treatment plans, the management of patients with head and neck cancer has become increasingly complex. At UCSF, our expert multidisciplinary approach to head and neck cancer care delivery includes integrating cutting edge research while always recognizing every patient's unique perspective.

Our Team Members

Head and Neck Surgical Oncology

• Patrick Ha, MD
• Ivan H. El-Sayed, MD
• Jonathan R. George, MD, MPH
• Chase Heaton, MD
• William R. Ryan, MD
• Bonnie Hindle, MPAS, PA-C
• Christian McNeill, PA-C
• Trina Sheedy, PA-C
• Mary Xu, MD
• Tiffany Ross, PA

Reconstructive Surgery

• Chase Heaton, MD
• P. Daniel Knott, MD, FACS
• Andrea Park, MD
• Rahul Seth, MD

Salivary Surgery and Sialendoscopy

• Jolie Chang, MD
• William Ryan, MD

Speech and Language Pathologists

• Cara Evans, MS, CCC-SLP
• Brittany L. Mitchell, MS, CCC-SLP
• Sarah Schneider, MS, CCC-SLP
• Erik Steele, MFA, MA, CCC-SLP
• Sky Yang, MS, CCC-SLP
• Lois Chen, SLP
• Nicole Rinne, MS, CCC-SLP