UAE surgeons reconstruct neck of patient with fist-sized tumour in high-risk surgery

Abu Dhabi: A multidisciplinary team of surgeons from the Sheikh Shakhbout Medical City (SSMC) have successfully performed a high-risk, complex oral surgery on a patient with a recurring tumour.

The patient’s neck had to be reconstructed after the surgery to remove the tumour, which was about the size of a fist.

The 42-year-old Filipina patient’s painful journey dates back to 2009 when she noticed a small lump behind her ear similar to the size of a bean. When she consulted her local doctor, she was initially prescribed paracetamol and eardrops. After a few years of ignoring acute pain, the lump continued to grow and the patient was then diagnosed with a parotid tumour.

Dr John Devine, maxillofacial, head and neck surgery consultant and division chair at SSMC, said: “The patient had presented with a parotid tumour, which is an abnormal growth of cells that form in the parotid glands, the largest of the three major salivary glands. After the first surgery in 2016, the patient had a recurrence of the tumour in 2018, and later in 2020, she underwent a biopsy, which identified that the tumour was a malignant acinic cell carcinoma. The patient came to us in 2021. We found that the tumour had become quite advanced, the size of a fist and was ulcerating her skin.”

Malignant diagnosis made it imminent to conduct extensive excision surgery.

Multidisciplinary team

Dr Devine, along with a multidisciplinary team, conducted a full investigation of a CT scan and a biopsy, which then confirmed the malignant state of the tumour and the potential to spread to other areas of the body. Once it was determined that the patient required surgery and that the tumour was operable, a multidisciplinary team comprising the maxillofacial surgeon, radiologist, pathologist, speech therapist, dietician, and physiotherapist conducted the surgery.

High-risk surgery

Dr Devine said: “The surgery itself carried several risks for the team to factor in and control, including facial paralysis being a key risk. We also had to design the surgery in a way that we were able to do reconstruction, which was needed due to the size of the tumour.

“We performed the procedure using a facial NIM alarm system to detect the nerves and remove the tumour along with a large part of the facial skin. We then took a segment of her upper arm, an artery, and a vein to reconstruct the area. We were pleased to have accomplished the removal and reconstruction within the same surgery.”

Rehabilitation post-surgery

Amira El-Sheshtawi, senior physiotherapist at SSMC, said: “Rehabilitation played a pivotal role in the patient’s recovery, as we focused on the treatment plan to restore the patient’s range of motion and activate the muscle strength of the neck and right shoulder. We also paid attention to the nerves that control the movements of the mouth and facial muscles and focused on deep breathing exercises and stimulating the lungs and respiratory system to avoid complications and improve the quality of her life after surgery.”

During the post-surgery phase, SSMC provided the appropriate care where the patient underwent speech therapy, had sessions with a physiotherapist and consulted with a dietician.

‘I’m so happy’

After her surgery, the patient said: “I was very pleased that the surgery went well and that I was finally able to get the help I needed after living with the tumour for such a long time. I’m so happy with the results and I’m very grateful for Dr Devine because he really went the extra mile, and the nursing staff were very caring and checking up on me daily.”