Early Diagnosis

An early diagnosis is the single most important factor contributing to a successful patient outcome.

Apart from the clinical examination, we use intra operative USS and other advanced methods such as 3T MRI on the same day and liquid biopsies.

After an initial consultation, Nick will be able to put a treatment plan in place or recommend any further diagnostic tests and scans that may be needed to form a clear and accurate diagnosis.

Whatever your treatment options, you’ll benefit from the support and expertise of a wider multidisciplinary team, including a dedicated clinical nurse specialist, a key component in the team who will coordinate your care from diagnosis to the completion of aftercare.

Depending on your diagnosis, the team may include medical and clinical oncologists, radiologists, pathologists, dieticians and speech therapists.

Your care does nor end once you finish your treatment, you will be able to access several wider services to support your ongoing recovery, including psychological support from trained counsellors and a range of complementary and holistic therapies.

Mouth & Facial Surgery

Malignant & Benign conditions.
Nick treats a wide range of malignant cancers and benign conditions, such as cysts, which when surgically removed can restore function and comfort to the patient.

They can impact various parts of the head and neck including the salivary glands, oral cavity and jaw.

Treatment Options
Some patients with cancer may only require one form of treatment while others may need a combination. This will depend on the size, type and location of your cancer and Nicholas will work with you to develop a treatment plan that’s tailored to your individual needs and wishes.

Patients under Mr Kalavrezos’ care also benefit from the ongoing research into early cancer detection and care at UCLH, a major research centre with one of the largest programs for cancer treatment in the UK.

Tumour Resection
Surgical removal of the cancer, known as a resection may be used alongside treatments such as chemotherapy, immunotherapy or targeted therapies. A biopsy may be carried out to determine whether cancer has spread to the lymph nodes within the neck - a neck dissection may also be performed to remove the lymph nodes that harbour cancerous cells.

Head & Neck Sarcoma

Surgery is frontline treatment for the management of these lesions.

Sarcomas are less common than carcinomas and require specialised surgical and multidisciplinary input. The way they grow and spread can present challenges that require specialist treatment.

As Lead Head and Neck Sarcoma Surgeon for the London Sarcoma Service, Nicholas and his team have a wealth of experience in treating highly complex and advanced head and neck sarcomas.

Fortunately they are relatively rare, but treatment must be provided within the frame of a dedicated Sarcoma Multi Disciplinary Team with surgical treatment offered by specialists surgeons with the successful outcome being linked to their experience.

Tumour resection

The area of the head and neck is comparatively small but complex, containing a multitude of organs, functions and nerve networks. Resection of head and neck sarcomas therefore requires both surgical precision and extensive planning to remove the cancerous cells while preserving the function of critical structures in the head and neck. As with carcinomas, a neck dissection is sometimes also required to remove cancer within the lymph nodes in the neck. Further treatments such as radiotherapy, chemotherapy and immunotherapy may be required.

Reconstruction Surgery

Microvascular Reconstructive Surgery
Successful head and neck surgery means achieving an outcome that restore function and aesthetics.

(Image: Tongue reconstruction with radial forearm free flap)

After a tumour is removed or after an injury is sustained to the head and neck, reconstructive surgery is sometimes necessary to manage function and maintain appearance. Microvascular reconstructive techniques involve transferring tissue with its own blood supply from another body part to rebuild the affected area.

Custom Prosthetics for Reconstructive Surgery
Custom-made prosthetics can now be created using 3D-printing technology to reconstruct bone and soft tissue. These are made and tailored to each patient's specific anatomy, which, when paired with precise surgical techniques, can help maintain the function of the head and neck when chewing and swallowing while helping the patient look and feel their best.

Salivary Gland Surgery

Salivary gland surgery is primarily used to treat tumours, persistent infections, or blockages caused by salivary stones.

Surgeons must take great care to preserve facial movement and sensation since major nerves run through or near these glands.

Salivary Gland Excision
Surgical removal of a salivary gland may be necessary for both benign and malignant tumours as well as recurrent infections. Nicholas uses ‘refined’ surgical approaches to minimise any scarring by making the small incision through facial creases whenever possible.

Common Surgical Procedures
The type of surgery depends on which of the three major glands is affected (video below)

Parotidectomy: Removes all or part of the parotid gland (in front of the ear). This is the most complex because the facial nerve, which controls expressions like smiling and blinking, passes through this gland.

Submandibular Gland Excision: Removal of the gland under the jawbone, usually because of stones or tumours.

Video: Major Salivary Gland Pairs - (we have between 600 and 1000 salivary glands)

Most surgeries take 1 to 4 hours under general anaesthesia, procedures are often outpatient, though some need an overnight hospital stay. Incisions usually take 1–2 weeks to heal, and most patients return to normal activities within that timeframe.

Ongoing: Removing one gland rarely causes dry mouth, as remaining glands compensate for saliva production.

Risks - Parotidectomy
Nerves controlling facial function run through the parotid gland - the largest salivary gland just forward of the ear. (background image) While generally safe, specific risks during surgery include Nerve Damage: Temporary or permanent facial weakness (rarely) or tongue numbness. Frey Syndrome: A rare condition which causes sweating on one side of the face while eating. Fistula: A collection or leak of saliva under the skin near the surgical site.

Sialendoscopy: (video below)
This is a minimally invasive procedure that uses a small camera and micro-instruments to remove stones or to dilate partially-blocked ducts without major incisions. The video illustrates the use of an endoscope containing camera, lights and instrumentation to break a salivary stone with sonic pulses and remove the fragments with a wire cage.

Sublingual Gland Excision:
Removal of the gland under the tongue, frequently performed for a cyst called a ranula.

Thyroid Surgery

Surgery is the most common treatment for thyroid cancer, goiters, (enlarged thyroid) and hyperthyroidism (overactive thyroid). The operation,(hemithyroidectomy) is minimally invasive with the average healing time being less than one week, leaving only a small scar.

Total Thyroidectomy: The entire thyroid gland is removed. This is the standard for thyroid cancer or large goiters and requires lifelong thyroid hormone replacement therapy.

Partial Thyroidectomy (Lobectomy): Only one lobe (half) of the gland is removed. The remaining half may still produce enough hormone, potentially avoiding the need for medication.

Near-Total Thyroidectomy: Almost all of the gland is removed, leaving a small amount of tissue to protect nearby structures.

Pioneering the Repair of of Major Defects in the Mandible:
- a Multilocular Lesion affecting the Whole Left Mandible

FORTE
(Fibula Based Oral Rehabilitation Tissue
Engineered Reconstruction)

Video requires audio.

Nick is a key figure in advanced techniques for oral rehabilitation using tissue-engineered components with fibula flaps.

Fibula-based oral rehabilitation using tissue-engineered (TE) reconstruction is an advanced surgical paradigm for restoring major jaw defects. It combines Vascularized Free Fibula Flap (FFF) with regenerative medicine to overcome traditional limitations such as bone height mismatch and poor soft tissue quality.

Nick's recent work in its further development is an advanced, tissue-engineered modification which improves oral and dental function.

This FORTE technique focuses on integrating tissue-engineered mucosa with vascularized free fibula flaps to improve functional and aesthetic outcomes in complex jaw reconstructions. The inclusion of dental implants adds the benefit of a complete dental rehabilitation when the defect is limited to the oral cavity.

Nick has pioneered the two-stage "prelamination" process where a fibula flap is prefabricated with dental implants and tissue-engineered mucosa before being transferred to the reconstruction site. He incorporates virtual 3D planning and 3D-printed cutting guides to ensure precise positioning of both the bone and the dental implants within the engineered tissue.

Whats happening in the video...

When reconstructing a jaw, the goals are to:

* restore the facial contour and symmetry,
* ensure the bone heals properly
* create a stable foundation for dental implants that integrate with the bone and support eating and chewing functions.

In the video, a tumour is affecting the entire left side of the jaw, changing its symmetry and function. In FORTE, the planning process is crucial for achieving precise reconstructive goals. On the computer screen, the jawbone is mirrored to reflect the correct shape, and planned bone cuts are made. This information is then transferred to the fibula image on the computer to simulate the surgery.

In this case Nick performed two osteotomies to facilitate the recreation of the facial contours and to help position dental implants in relation to the upper teeth.

The procedure involves a two-stage approach. Stage one utilises tissue engineering, combining cells, materials, or methods to improve or replace biological tissue. The desired surface of the fibula is exposed, and a custom-made surgical splint aids in the placement of dental implants.

In stage two, the tissue-engineered segment is exposed, and the fibula bone segment is harvested. A custom surgical splint acts as a guide for the bone cuts, and the implant-based dental rehabilitation is checked. This guides the final positioning of the bone, restoring contour and function when dental rehabilitation takes place with an implant-supported prosthesis (artificial teeth) to restore eating, speaking, and facial appearance.

The fibula-based oral rehabilitation tissue-engineered reconstruction technique minimizes the need for multiple operative sites, provides functional rehabilitation, and restores facial contour with special consideration to facial aesthetics.

Left: Similar Multilocular Lesion as video, different patient

Clinical Success: Nick's reported cases have shown that using dermal substitutes like Integra for prelamination can successfully generate mucosa-like tissue over fibula flaps, leading to satisfactory prosthetic and functional rehabilitation.

Notable Research:
Nick introduced the use of Integra in the context of free fibula flap prelamination for mandibular reconstruction. He also developed novel distractor devices used to increase bone height in fibula flaps prior to dental implant placement, further optimizing oral rehabilitation.

link: Nick: Published Research on FORTE at PubMed

Facial Trauma - Flap Surgery

Surgery involves repairing injuries to the face, jaw and neck, addressing damage to soft tissues and bones in order to restore function, improve appearance and address psychological impacts.

Flap surgeries
Common practice in flap surgery involves transferring tissue from one part of the body to another to reconstruct defects caused by cancer resection, trauma, burns or congenital anomalies.

Increasingly, Nick is using 3D scaffolds to grow tissue from the patient's own stem cells. The animation shows a gel being extruded onto a flat scaffold matrix which will be used as a tissue flap to repair or replace lost or damaged tissue. The gel contains the patients's own stem cells and nutrients which sustain the cells until the flap is attached to the patient's blood supply at the trauma area using micro-vascular surgery. Primitive stem cells used in this way have the capacity to take on the normal function of the cells in the trauma area, rather than retaining the characteristics of the tissue area from where they were harvested on the patient.

The flat scaffold itself is absorbed harmlessly by the body as the new tissue grows and becomes viable.

Nick has a wealth of experience in this particular area and has done extensive research at UCLH in micro-vascular flap surgery in the repair and replacement of tissue lost through surgery, burns or other injuries.

Scar Revision
Scar revision surgery aims to improve or reduce the appearance of scars often caused by facial trauma or tumour resection. The exact method will depend on the size, type and location of the scar but may include surgical excision, where the scar tissue is removed and the wound is closed with precision.

Patient Specific Implants

PSIs are custom-made medical devices designed and manufactured specifically for a patient's unique anatomy and needs. PSIs are created using computer technologies, using 3D printing for surgeons to use on areas where lesions have been excised. (PSI for jaw reconstruction)

Images courtesy of :
Sanjay Kumar,
Roy Chowdhury,
Karan Padha,
Sneha Singh,
Pradeep Yadav,
Ravi Prajapati
(Journal of Oral Biology and Craniofacial Research: October 2023)

TMJ disorders

If you have concerns and pain regarding your temporomandibular joint, we can support you through diagnosis and different treatment plans from Botox Injections to complex surgery (TMJ reconstruction with TMJ alloplastic joint replacement)

The Temporomandibular Joint (TMJ) is one of the most complex joints in the body. It lets the jaw open, close and move side to side.

TMJ disorders can manifest as pain that is felt when moving the jaw. Other symptoms can include headaches or pain around the ear and cheeks.