Can You Handle It?

This week I'll be spending most of my time with my sponsor, Dr. Rezaee, in Head and Neck OR (Adult ENT).  I've spent two days with him so far and I have seen quite a lot and suprisingly learned even more.  On Monday, I put on my scrubs and marched into the OR to the beginning stages of a 'free tissue transfer flap' surgery or 'free flap' surgery. This being my first sight in adult OR was a definite change from Peds ENT because literally half of this patients face was folded over onto the other side.  After the initial shock of seeing the jaw bone of a live human being, I actually thought the whole process was really cool and interesting.  It turns out that the procedure lasted for 11 hours and I was there for 8 of them.  There was a lot of buzzing and burning and squirting and stitching, but the patient was free of any apparent signs of cancer by the end of the long process which is always the goal.  Since this process is so long and involved, multiple surgeons of different specialties are working on the same patient at the same time.  This makes the room semi crowed but it yields the most effective result.  It also gives each surgeon the opportunity to work other rooms simultaneously and responsibly.  Any time Dr. Rezaee saw his direct services were not needed, he would go to another room and work on another patient.  The other procedure I saw him perform on Monday was a right partial thyroidectomy.  I had actually seen one of these in Peds ENT and I took the opportunity to compare the two.  The anesthesia was obviously different seeing as though the size of the field is dramatically larger for an adult than a child, but other anesthetics were used.  This is because most of the adults are elderly (60's and older) and they have been exposed to more external long term damaging effects.  Patients with diabetes, high blood pressure, hep B, smoking and/or alcohol history or illicit drug use have to be treated with different anesthetics due to the reaction period and effect of each drug.  Along with seeing the surgeries and enhancing my anatomy and physiology knowledge, I've learned a lot about anesthesia which has turning into an unexpected interest.

Today, I watched one surgery that consisted of several different procedures.  A right partial glossectomy was combined with a right partial pharyngectomy and mandibulectomy which resulted in what I think looked very similar to a free flap surgery.  A glossectomy is removing part or all of the tongue.  A phayngectomy is removing part or all of the pharynx and a mandibulectomy is removing a disease from the mandible.  Ideally, the goal of each of these procedures is to remove all signs and sources of cancer within a decent sized radius of the main cancer site.  The first link here is to a glossectomy and the second is to a mandibulectomy.


Glossectomy:

https://www.youtube.com/watch?v=weqg-oczsQc


Mandibulectomy:

https://www.youtube.com/watch?v=heFigZltayo


Seeing as though patient confidentiality is a huge issue with UH, I cannot take pictures of any actual procedure I observe so I'm stuck using what is already on the internet to give you a tiny snapshot of what I'm looking at all day...

...but I can take selfies :)