Vident Partners provides vetted head and neck surgery expert witnesses for cases involving thyroid surgery, nerve injury, neck dissection, delayed cancer diagnosis, airway complications and informed consent. Request a referral today.
Find a Head & Neck Surgery Expert →Overview
A head and neck surgery expert decides whether a cancer or mass in the neck, throat or mouth was found in time, and whether the operation was planned and done properly, with careful attention to the nerves and airway in that small space. Thyroid surgery produces the most litigation in this field. Voice, swallowing and breathing are all at stake, so injuries that look small on paper can change a person's life. This page covers surgical care of the head and neck. Routine ear, nose and throat care belongs to an otolaryngology expert, cosmetic surgery to a plastic surgeon, and tumor radiation to a radiation oncologist.
The expert reads the operative report, pathology, laryngoscopy before and after surgery, nerve monitoring records if used, imaging, voice therapy notes, anesthesia records and consent forms. A documented voice exam before surgery matters, because it fixes the patient's baseline.
The recurrent laryngeal nerve controls the vocal cord and runs close to the thyroid. A United States study of thyroidectomy litigation from 1984 to 2018 found that vocal cord paralysis was the most common reason for litigation, at 51 percent, and the majority of those cases ruled in favor of the defendant at 64 percent 1. Of those cases, 43 percent were due to unilateral nerve injury and 39 percent to bilateral injury 1. Where indemnity was paid, most included additional damages, such as lack of informed consent at 30 percent or permanent tracheostomy at 40 percent, which is usually a result of bilateral paralysis 1. So a one-sided injury is often defensible as a known risk, and a bilateral injury is a different kind of case.
A medico-legal review adds that the characteristics of the thyroid disease, the anatomy of the surgical site, and nerve identification and preservation are the factors that most influence whether liability is found, and that the clinical record is fundamental evidence 2. The operative report should therefore say whether the nerve was identified and how it was protected. An Italian paper describes thyroid surgery as at high risk of lawsuits, and reports that three-quarters of a series of 50 lawsuits resulted in conviction with financial damages 3. Legal systems differ, so that figure is not a United States measure.
A second group of cases concerns a head and neck cancer found late. The National Cancer Institute lists symptoms that include a lump in the neck, a sore in the mouth or throat that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice 4. It adds that those symptoms may also be caused by less serious conditions 4. It identifies alcohol and tobacco use as the two most important risk factors, and infection with cancer-causing types of HPV as a risk factor for oropharyngeal cancers 4.
A claim usually asks whether a persistent hoarse voice or a neck mass in a patient with risk factors was examined and sent for biopsy. Treating an adult's neck mass with repeated antibiotics is a recurring pattern. The expert sets out when the symptom appeared, what was examined, and what the stage likely was at each date, then addresses what earlier treatment would have changed.
Neck dissection puts nerves that control the shoulder, tongue and face at risk. A shoulder that will not lift after surgery can be a sign of accessory nerve injury. Claims ask whether the nerve was at risk from the tumor or from technique, and whether injury was disclosed and treated. Free flap reconstruction carries the risk of flap loss, so post-operative monitoring and the speed of return to surgery are read closely. Airway claims involve neck hematoma after thyroid surgery, swelling after surgery and tracheostomy problems. Those events move quickly, and nursing records and the time of each call are often the best evidence.
Look for a head and neck surgeon who performs the same operation regularly, usually an otolaryngologist with fellowship training in head and neck oncologic surgery. The American Board of Otolaryngology - Head and Neck Surgery certifies the field 5. If a general surgeon did the thyroidectomy, state law may call for a witness from that field on the standard of care. A speech pathologist may address voice and swallowing losses, and a life care planner may address future needs.
In a United States study of thyroidectomy litigation, vocal cord paralysis was the most common reason for litigation, at 51 percent.
Case Types
Recurrent laryngeal nerve injury after thyroidectomy
Bilateral vocal cord paralysis and tracheostomy
Delayed diagnosis of head and neck cancer
Spinal accessory nerve injury after neck dissection
Neck hematoma and airway loss after surgery
Free flap failure and monitoring
Parathyroid injury and permanent low calcium
Informed consent for thyroid and neck surgery
Qualifications
Related Specialties
FAQ
Look for a surgeon who does the same operation regularly, usually an otolaryngologist with fellowship training in head and neck oncologic surgery. If a general surgeon operated, state law may call for a same-field witness.
Not automatically. In a United States study, most vocal cord paralysis cases ruled for the defendant. Bilateral injury, permanent tracheostomy and lack of informed consent were features of cases that paid.
It should show how the surgeon approached the thyroid and whether the nerve was identified and protected. A medico-legal review calls the clinical record fundamental evidence.
It depends on the facts, including how long it lasted and the patient's risks. NCI lists a neck lump and voice change among head and neck cancer symptoms, while noting they may have less serious causes.
Neck bleeding and bilateral nerve injury can threaten the airway. The timing of nursing observations and calls to the surgeon is often the key evidence.
In general, head and neck surgery expert fees are determined by the expert themselves, based on a variety of criteria. Among those criteria are experience, the operation at issue, record and imaging review, the type of injury and the amount of testimony. Vident does have some influence over expert fees by comparing experts within a specialty, but ultimately it is a personal decision by the expert.
Related Insights
Most of us have signed a hospital consent form without reading every word. A recent Vermont Supreme Court decision, Ford v. Polomsky, shows what can happen when a patient later says, "I never agreed t...
Practice Area IntelligenceOver the past several years I have reviewed medical charts for both insurance companies and pain clinics to determine if what has been recorded makes good medical sense and shows an appropriate level...
Research BriefingFentanyl, a synthetic opioid, was first developed by Dr. Paul Janssen in the 1960s. From its inception, it was designed to be fast-acting, highly potent, and more readily synthesized than naturally oc...
Sources
Vident Partners connects attorneys with qualified head & neck surgery expert witnesses. Complimentary consultation, 24-hour turnaround, no obligation.
Request an Expert →