It is often impossible to determine the full extent of a particular patient’s problem until the surgery has begun. There is little question that the best time to address the entire disease is at the time of the initial surgery — not after the wound is closed and the patient must be sent elsewhere for more experienced care. Comprehensive care may involve removal of lymph nodes from the central and lateral compartments of the neck, removal of portions of the trachea and esophagus for invasive disease, or performing microsurgery to restore the patient’s voice if the nerve to the vocal cord is involved by the tumor or adjacent lymph nodes. We have the skills and experience to deal with whatever other problems the disease presents.