What we knew already
D has a cancerous tumour on the back of his tongue 2 centimetres in diameter
· His glands were swollen because of the tumour
· It is an aggressive cancer, without operating it can be fatal within twelve months. Removing
the tumour is the best chance of long term cure.
What we learned on Monday 26th March 2012
· The operation is expected to take 12 hours
· It will involve three teams
o ENT Surgeons
o Plastic Surgeons
The Operation Steps
Step 1. Insert Trachestomy
Tracheostomy is the name of the equipment used to enable D to breathe during the operation and after the operation.
The surgeon has advised that the Tracheostomy may be D’s way of breathing for three weeks.
During this time D will not be able to speak or make sounds. This is because there is no air going past the vocal cords.
Step 2. Gain Access to Back of Tongue
A partial cut will be made at the front of D’s jaw bone.
A plate will be screwed to his jaw bone with locating holes so that after surgery he can be put back together and his teeth will align properly.
Then they remove the plate and finish the cut down his jaw bone.
Once the jaw is cut through it can be swung out of the way to get access to the back of the tongue.
When it is finished the jaw will be swung back and the plate will be screwed into to place to hold the jaw and teeth in alignment. Eventually the bone will grow together again.
Step 3. Remove Tumour and surrounding tissue
·The tumor is two centimetres in diameter but the MRI scan shows it is deeper than initially thought and it extends down to the hyoid bone just above the voice box
·a safety margin of extra tissue will be taken from around the tumour
·During the operation the surgeon will slice the tongue back and test each slice to make sure there is no cancer left
·After the tumour and associated tissue is removed there will be a big hole.
·This will effect D’s breathing, swallowing and speaking.
Tubes will be inserted into various areas around his neck to drain the lymph for the first few days.
Step 4. Reconstruction
Next a team of plastic surgeons will begin working on D.
They will remove from D’s left forearm a flap of skin containing a vein and an artery.
This flap of skin will be used to cover the hole created at the back of his tongue. The vein and the artery will be plumbed into a vein and artery in his cheek. The reason they do this is to ensure the flap of skin has a blood supply and remains living tissue.
A skin graft will be taken from D’s left thigh to repair the area on his forearm where the skin flap was removed.
Step 5. Removal of Lymph Nodes
When the plastic surgeons have finished the Ear Nose and Throat (ENT surgeons come back to remove all the lymph nodes in D’s neck on both sides. This will include the lymph nodes which have grown the lumps that brought his condition to our attention. The cancer is called Squamous Cell Carcinoma and has metastasized (i.e. spread) from the tumour on his tongue to his glands. Cancer can move through the body through the lymph system (nodes) so it is important to remove all of these so that there is no chance that the cancer will be able to establish elsewhere in his body. A diagram of lymph node locations is below. At this time the jugular vein on his right side will also be removed because of the proximity of the growth in the lymph node.
Post Operation Care
D will return to Ward -- and be in a single room with a dedicated nurse looking after him and monitoring his breathing etc.
The first 72 hours are crucial. During this time the surgeons will monitor the success of the skin graft to his tongue to ascertain if the circulation is working. If the flap of skin dies the procedure will need to be repeated. It has been recommended that D has no visitors during this time.
D will be fed via a tube through his nose to his stomach.
The surgeon has advised us to expect D to be in hospital for at least three weeks. Before he can go home he needs to be able to breathe and swallow.
Long Term Outcomes
As the flap of skin across the hole in his tongue has no feeling D will need to learn to swallow again.
Speech therapists will help him to learn to swallow and then in the months ahead help him to learn to speak. The surgeon is confident that he will learn to speak again but has advised that he will not sound the same and may have some slurring.
The removal of the lymph nodes in his neck means he will have stiffness in his neck and weakness in his arms when it comes to lifting type actions.
The impact of the physical changes that D is going to experience will take time for him to come to terms with. He may not be fit enough to return to work and pass his Maritime Medical. His independence may be affected (e.g. driving) depending on the impact of the neck stiffness.
27/03/2012 5:46:13 p.m.
This is her way of coping. D is her second husband. She lost her first husband to Leukemia.