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

MORE ODDITIES

This baby has a large cystic hygroma-a congenital multiloculated lesion of lymphatic tissue. It can be difficult to excise completely. We operated and the surgery went well.

Cystic hygroma

 This 7 year old has bladder exstrophy-a congenital condition where the bladder is outside the abdominal wall. He also has abnormalities of the penis. Surgery for this condition is highly specialized so I referred the patient to an expert in this area.

Bladder Exstrophy

RETROPERITONEAL SARCOMA

We have completed 50 cases in the past 6 days. Today we started surgery with a lady who had a giant abdominal mass. At surgery we found a retroperitoneal sarcoma. It was attached to the transverse colon, spleen and stomach. We resected the tumor along with a splenectomy, colectomy and wedge resection of the stomach.

Retroperitoneal Sarcoma

Next we operated on a man with a giant inguinal hernia. He had the hernia for several decades!

Giant groin hernia

UNUSUAL THINGS

We have been seeing some unusual surgical problems-even considering that most of what we see is unusual.

Dr. Bock taking a break

This lady has had this parotid tumor growing for many years. We will resect it this trip.  It will be hard to preserve the facial nerve.

This man has an ameloblastoma. It has been growing for at least 5 years. Today we will do a hemimandibulectomy.

This lady developed a cystic forehead mass after head trauma. She probably fractired her frontal sinus and has a traumatic meningocoele.

Frontal sinus trauma

This man has a 4 year history of a mass of the upper lip. Biopsy showed basal cell carcinoma but he

never came for treatment. The lip has been constantly bleeding so he has been applying a salve. He will need resection of the entire upper lip.

Basal cell carcinoma

This is an intraoperative photo of a lady with a large abdominal mass. It is hard to discern from the photo but there was a very large mass approximately 12 inches in diameter coming off the stomach. The mass had the consistence of a brain! It was hollowed out and connected to a large hole in the stomach yet the mucosa of the stomach was normal. There were liver metastases. I am not sure what the pathology will show.

Gastric mass

NO TIME TO RELAX

The first 3 days of surgery have been a blur. We have done twenty-six cases so far. Dr. Dabs, Ifeanyi, Gbaanador and Drs. Bock are here assisting with the work. 

Dr. Gbaanador

Today we had a special visitor-the woman I did a Whipple Procedure on this past May came for a followup. Hre jaundice has resolved and she is doing well. She will start chemotherapy. 

Patient with ampullary cancer s/p Whipple Procedure

Despite working hard, there are still 21 patients waiting for surgery. More arrive every day.

TRADITIONAL HEALER OR ALIEN SIGNS?

This lady showed up with massive splenomegally. She had been treated by the local native healer.

Traditional healer signs

Alien signs

ARRIVAL

I arrived at NCH after 46 hours of total travel. Twenty-one patients were waiting for me! Here they are-pointing to their problems. Dozens more are pouring into the hospital. Surgery starts today.