WOULD YOU LIKE A MAMOSA?

A free upgrade to first class on a 12 hour Transatlantic flight is a great way to end a long trip!

HUMPTY DUMPTY

Mary came to NCH in August 2010. She had a tumor of the maxilla that had been growing for years. At surgery, we found that the maxilla was completely destroyed by the tumor-medial, lateral, inferior walls were gone. The orbital floor was also gone and the eye was sitting on tumor. The zygomatic arch was partially destroyed. The pathology showed fibrous dysplasia/ossifying fibroma. 

After resection of the tumor

As a result of the destruction of the maxilla, the face "caved in" after surgery since there was no bony structures to support it. In addition, there was a large defect between the sinus and the oral cavity. Mary also had difficulty closing her right eye. We performed a tarsorrhaphy which helped somewhat. Mary kept coming back for checkups and this trip we decided to do some corrective surgery.

We raised a temporalis muscle flap and placed it into the sinus cavity. This filled the facial defect as well as the defect between the sinus and the oral cavity.

The initial results are good but we will see how things look after the swelling decreases. We may need to place a support under the eye to rebuild the orbital floor.

Incision for temporalis flap

Flap raised off skull

Flap placed in sinus cavity

Results after 1 week

I THINK WE CAN AGREE

I think we can agree that this man looks better after surgery. It will be interesting to see what the pathology shows. We will do some reconstruction on his palate in the future or, perhaps, obtain an obdurate prosthesis which can isolate the nasal cavity from the oral cavity.

Maxillary Tumor

After central maxillectomy. The dark area below the lip is
the nasal cavity.

Postoperative day 1-Rapid Rhino nasal packs in place to
control bleeding, tracheostomy tube removed

AMELOBLASTOMA REDUX

This man came in with a slow growing tumor. He is from River State-quite far from NCH. He has an ameloblastoma.  The mandible was paper thin and completely replaced with tumor and fluid from the midline up to the temporomandibular joint. We performed a hemimandibulectomy with disarticulation of the joint.

Ameloblastoma

After hemimandibulectomy

Mandible cut longitudinally- completely replaced with tumor

WORK IS OVER

We performed 159 cases in 21 days. I am going home. The work is over but the job isn't done. We still need to get the pathology results and decide on treatment plans for the patients with cancer. The next trip is in July and patients are already waiting.

IF IT BLEEDS, WE CAN KILL IT

I don't know what this is but it is the worst case I have ever seen. The patient walks around with a rag over his mouth and looks like a robber. We will operate tomorrow!

SCRUB TECHNICIAN/RN

Prince Ezenwa is our new surgical technician. He has been in OR for 3 months. He is quite good.