AMELOBLASTOMA REVISISTED

Preop 

Today we operated on a man with a large central jaw tumor. It is most certainly an ameloblastoma. We had to resect the mid-portion of the lower jaw since the tumor, which started on the left side, extended to the right. In the USA, this patient would have reconstruction of the jaw. We don't have the capabilities to readily do this. We also can't readily invest an entire day working on one patient. The patient will have a functional result but it will not be the best cosmetically.

Jaw specimen

Postop

Addendum (5/19/12) What a patient! He never complained about pain and was always smiling!

ADVANCED BREAST CANCER

It is to earlier diagnosis that we must look for any material improvement in our cancer cures-John Lockhart-Mummery, 1926

This is another case of advanced breast cancer. It is terrible! We can't do much for the patients when they arrive so late. We are intensifying our efforts at education so that these cancers are found earlier.

BEFORE AND AFTER

My fatal flaw is hubris-Rick Riordan

Here is our first parotid patient-before and after. A great result but we won't get too cocky because you are always just one case away from disaster. 

VENTRAL HERNIA

This lady had a large ventral hernia with a palpable mass about 6 cm in diameter. We performed a ventral hernia repair with mesh and removed the mass. It was an ovarian teratoma-full of hair!

Mesh repair

Dermoid cyst

HERE IS THE TEAM

This is a hard working group. We have done 84 surgeries in the past 9 days!

A DAY'S WORK

A baby screams as it gets ketamine for its hernia repair. Dr. Bock and Dr. Ifeanyi are doing a bilateral inguinal hernia repair. Dr. Uche is doing a total thyroidectomy. Prince, the CRNA is getting a lady ready for a laparotomy after a motor vehicle accident (she had a blunt perforation of the cecum). A post C-section patient is bleeding from DIC. A patient with a fistula in ano and another with an inguinal hernia are waiting for surgery. A man with breast cancer who has had 3 courses of chemotherapy is ready for a mastectomy. Patients are coming to the OR complaining about waiting for surgery while others are complaining about their bills. I am seeing patients in clinic-making snap major decisions about surgery with inadequate information. If I could only clone myself!  This is a day's work in Nigeria. 

PAROTID TUMORS

Parotid tumor

There seems to be a lot of parotid tumors in Nigeria. The disease is usually advanced and the patients often have had a previous surgery. Many of the tumors are mucoepidermoid carcinomas and the patients usually die within a year or two. The surgery is difficult as the facial nerve courses under, over or through the tumor. We always attempt to save the nerve but it is not always possible. If the nerve is injured, the patient loses the function of many facial muscles. One of the most serious is loss of innervation of the orbicularis oculi muscle, which closes the eye. As a result, the cornea is not adequately protected and lubricated. This causes a dry eye feeling and can result in corneal ulcers. A tarsorrhaphy can be performed to correct this problem, if necessary.

The young woman pictured here had a recurrent parotid tumor.  The tumor invaded the facial nerve and the masseter muscle. We did a radical resection, including the facial nerve, masseter and also performed a modified radical neck dissection. She is doing well.