148

Of course, we ended up doing 3 more cases-patients that arrived at the last minute. The last case was a 69 year-old woman with a large tumor of the cheek. The tumor was located under the superior aspect of masseter muscle and had eroded into the lateral wall of the  maxillary sinus, partially eroding the lateral and inferior walls of the orbit and destroying the zygomatic arch. The tumor filled the maxillary sinus but appeared encapulated, suggesting it grew into the sinus rather than from the sinus. This was a very interesting and technically challenging surgery. We approached the mass from a parotid type incision. We were able to completely resect the tumor.  It was not clear where this tumor originated.

From this diagram, it is apparent how this tumor could cause the damage described. The aponeurotic portion of the muscle arises from the area of the zygomatic arch, and is near the orbit and the lateral maxillary wall.

145

This lady is our last case of the trip-case number 145 in 3 weeks. Everyone has worked very hard and it is amazing that we could do so much. We are already making plans for the next trip.

BIGFOOT

This lady presented with a 9 year history of foot swelling. This is possibly elephantiasis. She may also have TB so we are treating that first.

A Big Foot

Another Bigfoot

MORE STONES

A 20 year old man came in with a complaint of a bladder stone. We opened his bladder and he was right! The stone is quite beautiful.

SNACKS

When we get hungry in the OR, we send out for a snack-fried plantains. A small pack of 5-10 strips costs about 33 cents. Better than potato chips!

BREAST CANCER

As I have discussed previously, breast cancer is a bad problem in Nigeria. in the past several days, I have seen 2 patients aged 25 years with breast cancer. Many patients present in the late stages with necrotic tumors.

Young female with breast cancer

This poor woman has an enormous cancer. Immediately after I took this picture, the tumor started hemorrhaging. The patient lost several units of blood before I got her to the operating room and performed an emergency radical mastectomy! She is doing well now. 

Hemorrhagic breast cancer

This poor lady has recurrent breast cancer in the axilla. She had a previous modified radical mastectomy but I suspect the axilla was inadequately treated. 

Necrotic axillary tumor

GOITERS

Every trip we have a lot of patients with goiters. This trip is no different. Many are large, bilateral, and substernal. We have done 25 total thyroidectomies in the last 12 days. 

Goiter

Large goiter with intrathoracic component

Large goiter that was cancerous

Opened specimen