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BRITCOM 4
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00:00This program examines medical conditions and the procedures involved with treating them.
00:04Due to their graphic nature, viewer discretion is advised.
00:09I was born a normal baby, but over time the tumor started to grow.
00:14Every single interaction is a reminder that I'm different.
00:20This is a very widespread infiltrative type of tumor. It's kind of large. Is it kind of heavy?
00:26Oh yeah. It's got some weight to it. Yeah, I can feel the weight.
00:28You don't know where the normal begins or the tumor ends.
00:32Treating it is not as straightforward as it may look.
00:36We have to be pretty precise about how you remove it.
00:40If we don't get these muscles on the right tension in the right direction, it can't function as a mouth.
00:46Looks like this is a bleeder. It's basically racing against blood loss.
00:50Move, move, move.
00:51Trying to remove more tumor is just going to be life-threatening.
00:54If we can't get control of it, then we've got to stop.
01:02Hello.
01:06Oh, hey.
01:07Hey, Andre.
01:08How's it going?
01:09What's happening?
01:09How's it going, buddy?
01:10I'm good.
01:10What you got?
01:11Okay, so I have a patient coming in. His name is Trey Matlock, and he's got tumors. And these tumors can be massive.
01:20Trey's case is a condition called neurofibromatosis. And, you know, I deal with this condition a lot.
01:28I specialize in it. And when it happens on your face, it's pretty noticeable. It's almost impossible to hide.
01:34Mm-hmm.
01:35It sort of distorts the half of his face. It goes across the scalp area. And it actually dives down along
01:43his hairline in the back. It's almost like it gives you the impression that it's hanging.
01:47Yeah. It's like, I mean, it's literally pulling his eye down.
01:50The weight of it looks like it's pulling the corner of the eye down.
01:54It just looks swollen. It almost looks like a boxing match to me. I mean.
01:57Yeah.
01:57His ear's actually a little bit lower and almost even tilted back.
02:02We want like, what, a 20-degree tilt? And this is like close to 90.
02:05Exactly.
02:06So the idea is to get him some sort of relief from the tumor.
02:10But one of the things that I always worry about, these things bleed.
02:14They bleed a lot. And they bleed fast. I'm talking about life-threatening bleeding.
02:18I mean, it's already a very vascular area. I mean, people can literally bleed to death
02:23from the scalp if you don't get it closed.
02:25I can tell you that a lot of people try and they've aborted the surgery because it was too much
02:30bleeding. And they didn't account for that when they went in.
02:33Yeah. I mean, I think it's going to be challenging, but...
02:35I think it's worth a shot.
02:37It's definitely worth a shot and he's in great hands with you.
02:39All right. We'll do it.
02:46I want to be able to go out and not have kids scared of me or wonder what's wrong with me.
02:53It's a genetic disease. One in 3,000 people, I believe, have it.
02:59I got it from my mother who got it from her mother.
03:01And I'm the only one from my generation who has it.
03:09Every day, I get a sharp pain on the side of my head.
03:19I was born a normal baby. But over time, the tumor started to grow.
03:24I first noticed I was different in elementary school because I tried to play sports like football.
03:32And when I tried to put a helmet on, it didn't really fit me like the other kids.
03:35It was hard for me because I just wanted to be a normal kid and play sports with all my friends.
03:43But I really couldn't play because of my condition.
03:45I have a tumor on the back of my neck that hangs down.
03:53I have a tumor here, a tumor here.
03:56And also, my ear, it causes it to deform. It sits lower than my other ear.
04:02When I look in the mirror, my biggest fear is that the tumor will get bigger and eventually just grow and grow.
04:09I don't want to hide who I am.
04:18What's up, man?
04:19What up, brother man? How you doing?
04:20How you feeling?
04:21Good, good.
04:21It's good to see you, bro.
04:23Always.
04:23Always.
04:24Always.
04:26So what they talking about, man? What you got going on?
04:28Elijah is my best friend. We knew each other about nine years, going on 10.
04:33We met in college in Southern Colorado.
04:36I feel more comfortable with him than anybody else.
04:38He really brings me out of my show.
04:41Like, he doesn't let me get inside of my own head. He keeps me going.
04:45You ready for some football?
04:47Yeah, well, we're out there. We got to catch, like, a Rams game or something like that.
04:49Let me see if we can get some tickets out here, man.
04:52Probably going to be gouging us for the tickets, though.
04:54For sure, bro.
04:55Like, I'm trying to keep my mind occupied, not really, like, thinking about going, like, going out there.
05:00But at the same time, like, my mind's been racing about going out there.
05:03Right.
05:03The plan is to fly to Los Angeles and meet with Dr. Pernozian.
05:07And Elijah is coming with me because he's been there for me since the beginning.
05:11And I really want him to be there to support me now.
05:14Hoping they can just do as much as they can and just make me feel more confident.
05:20Yeah.
05:20Like, when I walk around in public, it feels like everybody's eyes on me is, like, the spotlight.
05:24Like, I want to be able to just walk around.
05:27Yeah, and I see that, too.
05:29Yeah.
05:29Obviously, I would be lying if I didn't say that I saw a physical difference.
05:33But because I was able to start building a friendship with him immediately, it was more of who he was as a person.
05:39His strong will and his ability to push through something that not many people have to deal with.
05:45And when you get past that shy exterior, he's always wanting to have fun.
05:49I want other people to be able to see that also.
05:51It's the hardest thing for me, like, to not, uh, not notice back.
05:56Yeah.
05:56And it hurts sometimes because I want to feel how I feel on the inside, on the outside.
06:01The inside of me loves to go out, loves to have fun, play sports with his friends.
06:09But the person on the outside wants to isolate itself.
06:13Just hang out inside and not be around people.
06:18Just never be seen again.
06:20Growing up to L.A. soon, man, I'm really excited to do this.
06:23You feeling nervous since it's new doctors, new experience, new environment type of thing?
06:27Yeah, yeah.
06:28Like, I've had, like, a lot of people, like, tell me no or, like, we're too scared to do it.
06:35And this is not, this is, like, a great opportunity to see what can be, you know?
06:39So I've seen many doctors who told me they can't do the surgery.
06:42They don't want to take the risk because it's a very bloody surgery.
06:46Like, I felt like I was helpless and no one could help me change, like, my condition.
06:51You got some of the best doctors in the world working on it, too.
06:53So that's another bonus.
06:54Okay, it's exciting.
06:56I am very nervous to meet Dr. Pranozian because I've heard no so many times.
07:00I don't want to get my hopes up and just have nothing to let down.
07:02Hello.
07:12Hi.
07:13Want to see you Dr. Pranozian?
07:14Perfect.
07:15If you could sign in.
07:15My emotions are on a roller coaster right now.
07:18I'm hoping you can help me.
07:19Just excited, nervous, anxious, scared.
07:25Everything is all going to one right now.
07:27All right, we're here.
07:32I know, man.
07:33It's exciting.
07:34I got a little nervous just now.
07:35Yeah.
07:36Bro, hospital rooms always get me.
07:38I don't know why.
07:44Looking at trace photos, I'm seeing a giant tumor.
07:48This is definitely on the extreme side.
07:50This is a very widespread, infiltrative type of tumor.
07:55I'm always worried about bleeding.
07:56These tumors are fast bleeders.
07:59They don't clot normally.
08:01In a matter of seconds, you can lose hundreds of cc's of blood.
08:05There's a ton that can go wrong with this.
08:07He's just going to come in here straight sedate you and start surgery right away?
08:09That's all I want, bro.
08:10Come here, do this.
08:12Hello.
08:12How are you doing, sir?
08:13Hey, how's it going?
08:14Good, how are you?
08:15Great.
08:15I'm Dr. Penosian.
08:16Good to meet you.
08:17Good to meet you.
08:17Nice to meet you, Elijah.
08:19And how are you guys related?
08:20Basically, my brother, like my best friend.
08:22I knew him since college.
08:23Your buddy's getting surgery.
08:24You're going to come out.
08:25Absolutely.
08:25You know, I got to be there for moral support, right?
08:27Yeah.
08:28So let's talk a little bit about why you're here today.
08:31I was born with neurofibromatosis.
08:33Pretty sure you know it's like a genetic disease.
08:35And it's going to pass down for me from my mother,
08:37who got it from her grandmother.
08:38And just trying to figure out the next step of having surgery with it.
08:41Neurofibromatosis is a genetic condition.
08:44You're born with it.
08:45And it involves the formation of nerve-related tumors throughout the body.
08:50Sometimes they can be these smaller, very discrete masses.
08:53And other times, such as in trite, it's this big continuous mass.
08:57And they pose a big reconstructive challenge.
08:59Let's take the glasses off for a second.
09:01Let's take a look here a little bit.
09:08I'm going to just sort of look at everything starting from the back here.
09:11And it looks like you've got a nice large piece still back here in the back of the scalp.
09:15Yes.
09:15It's kind of large.
09:16Is it kind of heavy?
09:17Oh, yeah.
09:17It's got some weight to it.
09:18Yeah, I can feel the weight.
09:19So I can lift it up and just feel like a difference when I lift up rather than when it's down.
09:24It's probably adding somewhere around a pound or two to his head weight.
09:28Now, it doesn't sound like much, but if he turns his head, if he moves, it sort of swings.
09:34So you're adding that mass, that momentum mass there.
09:38And slowly growing is a lot.
09:41He can develop some spinal issues as time goes.
09:43And we're going to have a serious problem.
09:48This is the most critical part of the surgery.
09:50Ambie could be left with a huge hole in her cheek.
09:56Shoot.
09:56It's a lot of bleeding.
09:58These dark pools of what looked like squidding kind of scored out.
10:01Keep them coming.
10:02Keep them coming.
10:02Now, it's a race against time before we get into a life-threatening situation.
10:06Move, move, move.
10:19Now, the most obvious thing that I'm seeing here is the position of the ear has changed.
10:24So it's a little bit further back, and it's sort of dropped down, and it's also kicked out a little bit.
10:29It looks like you have what we call a plexiform neurofibroma, basically ill-defined tumors.
10:35There's no perfect border to it.
10:37When people think of tumors in general, they may think of something like a little marble popping right
10:44out or a little golf ball or something like that.
10:45Some people even talk about a big softball.
10:47But what Trey has is completely different.
10:49They're sort of what we call diffuse.
10:51They enter the tissues.
10:52You don't know where the normal begins or the tumor ends.
10:56Now, we've got that mass here, and it sort of continues.
10:59And obviously, it goes all the way to the back of your scalp.
11:01But the good news is that we do have a surgical option here.
11:06Like, this is, like, really exciting for me to, like, actually have the opportunity to get a surgery.
11:11My plan for you is remove the tumor as much as possible in one surgery.
11:17Okay.
11:18The bigger it gets, the harder it is to remove.
11:21If we don't get to him now, this is going to potentially grow and give him spine problems,
11:25maybe sit on the facial nerve and give him some facial nerve paralysis.
11:28So we do need to address that.
11:30So once that tumor's removed and much of it's gone, I'm going to reposition the ear,
11:34anchor it back down against the skull.
11:37Then we can really kind of look at that symmetry and just nail it down.
11:40Okay.
11:41At this point, I want to take some photos of you, 3D photos to be exact.
11:44What that allows me to do is sort of figure out what we might expect out of the surgery.
11:48Okay.
11:49Look at a point over in the distance in front of you.
11:52Okay.
11:52And these will just be a few quick little pictures here.
11:57It's really helpful when we have this technology because we can then, in real time,
12:02show the different problems from different perspectives, which helps people understand
12:06not only the severity of their problem, but what we are going to do to help correct it.
12:11So this is you.
12:12Oh, wow.
12:13And we'll outline that bulge area and sort of pull it in.
12:18Wow.
12:19That already makes a huge difference.
12:20Isn't that great?
12:21Yeah, it's crazy.
12:22Oh, wow.
12:22It's a big difference.
12:23This is your post image to show what our goal is, to move that cheek volume back in.
12:29Looking at those pictures gave me a lot of, like, hope.
12:33This is what we might see afterward, the tumors removed from this location.
12:38What do you think?
12:39Seeing this gave me, like, the utmost, like, excitement for this.
12:45Great.
12:45That's our goal, and I think we can get pretty close to that.
12:49Now, with that said, one of the challenges is going to be these tumors have a risk of bleeding
12:56quite a bit, and if it bleeds way too much, we have to stop.
13:00The scariest part is if the doctor can't do anything for me, the tumor will get bigger,
13:05and eventually this grow makes me feel this anxious all over again.
13:11So this part way back here in the scalp, I think that would be a good starting point.
13:15Okay.
13:15Because that will give me an idea.
13:17Does this tumor bleed while staying safe in an area that's going to heal fine?
13:20Okay.
13:21So we can move forward with doing the surgery.
13:24I'm really excited for that.
13:26Great.
13:27I'm happy, like, really.
13:28Terrific.
13:29I really hope that Dr. Pernosian can help me because I want to be able to start my life
13:34with dating, going out, hanging out with my friends and everything.
13:38Going into this type of surgery, we got a lot of questions.
13:42For big, giant neurofibromas like this, I'm hoping we get all of it out, if possible.
13:48But the worst case scenario is if we just make our opening incision and it just bleeds way too
13:52much and we have to stop.
13:53Excellent.
13:54Boss, any questions?
13:55Nothing for me.
13:56I'm excited for him.
13:57I just told him, as long as he doesn't look prettier than me after, then we're good to go.
14:02We're ready for surgery.
14:03All right, let's do it.
14:04Okay, excellent.
14:05Thank you, sir.
14:06Much appreciated.
14:06I'm excited for it.
14:07Great to meet you guys.
14:08See you soon.
14:11So I have a patient coming in today.
14:21Her name is Ambie, and Ambie was born with a vascular birthmark or a vascular malformation
14:27of the corner of her mouth.
14:28My biggest concern regarding Ambie's birthmark is really how big it is internally.
14:35There's a component that I can see on the outside, but there is a strong chance that there
14:40could be a more extensive involvement inside the mouth as well.
14:44I may not be able to take the whole thing out because it would just leave a giant hole at the
14:48corner of her mouth and on her cheek.
14:50That would end up causing way more problems than she currently has.
14:56Growing up, kids would call me fishhook face.
15:00Being bullied and called names.
15:05Every single interaction is a reminder that I'm different.
15:09Me first?
15:15Yep.
15:16Age over beauty?
15:18I can remember all the way back to kindergarten and wanting to, like, kiss a boy and the boy
15:25saying, I'm not going to kiss you until you take care of that thing on your face.
15:29No way.
15:34Yes!
15:34Did it go in?
15:36It went in.
15:37Yeah, it did.
15:37You want to sit down?
15:39Mm-hmm.
15:41When I was born, it was just a tiny little purple speck in the corner of my mouth,
15:45but it just continued to grow as I grew.
15:48I had surgery when I was five where they took out a good portion of it.
15:53And then between then, through my teenage years, we tried a laser treatment.
16:00We did a couple saline injections to try and shrink it.
16:03And at that point, they had told me there really wasn't much more that could be done.
16:08I had kind of reserved myself to believing, like, this is, this is it.
16:12Oh, my goodness.
16:15Did you have fun?
16:16Yeah, it was awesome.
16:17Yeah.
16:18So are you ready? How's it going to feel having surgery now?
16:25I think I felt very discouraged after that last consult.
16:29He was just very adamant, like, there's really nothing more we can do.
16:34I think there was, like, a part of me that was, like, scared to inquire
16:38for the fear that the answer would still be no.
16:41Yeah.
16:42A big reason for wanting surgery was just so I didn't have to, like, worry about,
16:48you know, having it bleed.
16:50It can bleed very easily.
16:53If I eat something sharp, if my dog nips at me in the wrong spot,
16:57it bleeds and it doesn't stop until the skin is healed.
17:00And the skin can't heal so long as I'm talking or moving my mouth.
17:05It's just very exposed and vulnerable.
17:07So how's it going to feel not to have to worry about people staring in public?
17:14It's, like, it's something that's been my reality my whole life.
17:18I think it'll be a burden off.
17:20You know, I think I'll start to kind of, like, open up a little bit.
17:24So the plan is I'm going to go to L.A. and meet with Dr. Ravello,
17:28and she's going to let me know if there's anything she can do for me.
17:33I'm excited. I'm excited. I'm nervous.
17:36I'm going to miss my little buddy.
17:37Yeah?
17:40You little weirdo.
17:47Hi.
17:48Hi. Welcome.
17:49I'm here to see Dr. Ravello.
17:50Great.
17:55I get people saying, what is that on her face?
17:58Why doesn't she get that taken care of?
18:01Go ahead and take a seat.
18:02My doctor will be with you shortly.
18:04It's exhausting and it does hurt when it's pointed out to you your whole life that it's different.
18:11Oh my goodness.
18:15Hello, hello. Hi.
18:16Hi.
18:17How are you?
18:18I'm good. How are you?
18:19Very good. Good to see you.
18:21Yeah, good to see you too.
18:23Andi, Josh.
18:23Hi.
18:24Josh. Josh is?
18:26Partner.
18:27Partner.
18:27You know, I always ask.
18:28I have to clarify because I've made some mistakes.
18:30Oh, you brought your mom with you.
18:32Oh my god.
18:33Oh, that's my wife.
18:35How are you feeling today?
18:36I feel good.
18:37I feel excited.
18:38Good.
18:39Good, good.
18:39Yeah.
18:40If you don't mind, let's take the mask off.
18:42Let's do it.
18:51And let's talk a little bit about why you're here.
18:55What's going on?
18:56So, I have a vascular malformation that I had surgery on when I was little.
19:0420 years ago, they said there wasn't much else that could be done.
19:08I've kind of just accepted that reality and lived my life.
19:13So, how old were you when you first had a surgery for this?
19:17I was five.
19:18You were five years old.
19:18I was five, yeah.
19:19Okay.
19:20And after they did the first surgery, was that malformation completely gone?
19:26Or did you still have some left behind?
19:27There was definitely some left behind.
19:30That small part that was left continued to grow as I grew.
19:34Got it.
19:35This is going to definitely keep growing and could become a huge problem.
19:40We have to address this.
19:41Well, with that in mind, may I take a look?
19:44Let's do it.
19:44Okay.
19:46Does any of this hurt?
19:47Does it hurt when it's touched?
19:48Not at all, no.
19:49Okay.
19:51Close your mouth here.
19:52Mm-hmm.
19:53So, what I can see here, you have this scar from your previous section that comes down
19:59vertically this way.
20:00Okay.
20:01Then open a little bit.
20:02And then on the outside, you have this kind of conglomeration of abnormal blood vessels
20:09coming out the corner of the mouth.
20:11And then open again.
20:13It continues around to the inside for a couple centimeters.
20:16Uh-huh.
20:17And so it's really almost kind of like this wrapping around the corner of your mouth.
20:23Okay.
20:23And then open all the way.
20:26Okay.
20:26Ambie's malformation is in a very tricky area.
20:30The external part involves the corner of the lip.
20:33And then on the inside, it's pretty large.
20:35I mean, it's definitely a couple inches at least.
20:39That means that I can't remove the whole thing.
20:41I can't take out this entire malformation because it would be half of her cheek.
20:46This definitely makes things much more challenging.
20:53This program examines medical conditions and the procedures involved with treating them.
20:57Due to their graphic nature, viewer discretion is advised.
21:01And then close your mouth and do like a whistle blowing move.
21:05Yeah.
21:06And then go like this.
21:07Yeah.
21:08So you have really good muscle.
21:09That's good.
21:09The muscle is retained and strong.
21:12Strong mouth.
21:13You have a strong mouth.
21:14Wow.
21:15So when I was examining Ambie, I noticed that the external part of this malformation actually
21:22curves around and then extends into the inside of the cheek.
21:26This may not be the largest malformation, but its location makes it very tricky and complicated to
21:33treat.
21:34So I'm sure you know or you've been told before that this is a hemangioma.
21:38A hemangioma is a collection of abnormal blood vessels.
21:42You're born with it.
21:43The problem with yours specifically is the location.
21:46That corner of the lip has a very vital function to the lip.
21:50It controls a lot of the movements of it.
21:53The other concern is that it goes all the way around and is through and through.
21:58Yeah.
21:58So it's going through all the layers of the lip.
22:01That's the inner lining, which is the mucosa, the muscle, as well as the skin on the outside.
22:06Okay.
22:06That side of the lip is already a little bit shorter than the other side.
22:10Yeah.
22:11And further surgery to remove that area could shorten it a little bit more as well.
22:16Yeah.
22:17So treating it is not as straightforward as it may look.
22:21You can't just cut it out and sew it back together and call it a day.
22:24Right.
22:24And that's because it involves so much of that critical part of the mouth.
22:28Mm-hmm.
22:29I do think it is possible, though, to remove it or perhaps only one part of it.
22:34Since the outside is the part that we can see, I think we can definitely start by addressing
22:40the outside part first.
22:41Yeah.
22:42Does that sound like something you might want to do?
22:44Yeah.
22:45Yeah.
22:45Let's do it.
22:46Yeah.
22:46Okay.
22:46Good.
22:48All right.
22:48Let's do it.
22:49All right.
22:51My concern about this surgery is how much of a normal lip I'm going to be left with
22:57once we remove this vascular malformation.
23:00We have to be pretty precise about how you remove it.
23:03If you go in there and you start cutting away muscle, now you've actually lost the function of the lip.
23:14It's finally here.
23:28The day is here.
23:29I'm a little nervous, to be honest with you.
23:31I'm, like, a little nervous for you and I can only imagine what you're going through.
23:34But yeah, man, just going with the punches, going with the flow.
23:38Hello.
23:39Hey, how are you guys?
23:40How are you doing?
23:41You ready?
23:41Yes.
23:42Awesome.
23:42Good to see you, sir.
23:43All right.
23:43This is it.
23:44Oh, yeah.
23:44I'm ready.
23:45For me, this is a challenge, but it's also fun.
23:47So I like seeing the changes and, and, you know, you get the benefit from that, too.
23:52Oh, yeah.
23:52I'm hoping for the best.
23:54Yeah.
23:54And, like, anything you can do for me is amazing.
23:56What are you going to do in the meantime?
23:58Sunday football, man.
23:59I'm going to watch some football.
24:00I'll wait around.
24:01Let's get in there and get this done, okay?
24:03Thanks, sir.
24:03All right, good.
24:06That made me feel a lot better, too.
24:07Yeah.
24:08Like, just him being relaxed, joking around.
24:11It's like, I'm more relaxed, more ready now.
24:13Yeah.
24:13It's game time.
24:15I'm ready.
24:18Today is Trey's surgery, and nerve fibromatosis is one of my specialty areas surgically.
24:23So I, I deal with this a lot, and they are challenging.
24:27All right.
24:29Okay.
24:30You can knock out the nerve.
24:31You can create some life-threatening bleeding.
24:33So we always have to think about how to approach the problem.
24:36All right.
24:37So we got our patient here, Trey.
24:39I think we can just kind of dive in, scoop out as much of that as possible.
24:42Today, I'm helping out Dr. Panossian with Trey Matlock.
24:45This is a very impressive tumor.
24:47He has entire areas of his scalp that don't grow hair because it's completely covered and involved by the tumor.
24:54I'd like to get rid of all this stuff, too.
24:56For sure.
24:56This stuff is...
24:56That'll make a big difference.
24:57Yeah.
24:58My plan for Trey today is to start with the tumor on the back.
25:02The nerves are not that important in that area.
25:05And it gives me a sense for how much bleeding I'm going to encounter.
25:08Incision.
25:10Start with a little something like this.
25:18You can kind of tuck.
25:19Already looking kind of amorphous.
25:21That's what these things look like right here.
25:23It's kind of little forms of grapes and worms.
25:26It's kind of what it looks like.
25:28Look at that.
25:28It's like gray in there.
25:29It's definitely not normal.
25:30Yeah.
25:31See that?
25:31Look at that.
25:32That's the grayish, junky tissue.
25:33That's tumor.
25:35It's crazy looking.
25:35Look at that.
25:36It's like ink.
25:37It's like octopus ink.
25:38I was going to say, it looks like squid ink.
25:39These tumors got multiple colors and tones to it.
25:43Texture is different.
25:45All of it's almost gelatinous in terms of what you're touching.
25:47It's like jelly almost.
25:49And some of it is the tumor.
25:50Some of it is the effect of the tumor on the normal tissues.
25:53So I got it in my hand about a size of a softball of the tumor.
25:57And that's going to end up coming out.
25:59And then we're going to see if we can take out some more after that.
26:02We have a big giant piece to quickly go through the stuff here.
26:05I'm going to just take out more tumor from underneath it.
26:09It's a big old deal.
26:12It's a big dinner.
26:13We just got rid of a lot of this tumor, but it's huge.
26:17There's still a lot of tumor left that I got to go after.
26:20Give me a knife again, please.
26:24Shoot.
26:26So yeah, we're getting a bunch of bleeding right now.
26:28And I think that that's sort of characteristic of these tumors.
26:31And this is what scares a lot of people to approach this from the surgical side.
26:35But I think it looks like this is a bleeder.
26:38That's a high flow.
26:39That's a high flow.
26:40Now this tumor is going.
26:41It's bleeding.
26:42And there's no way to stop it other than just put a hand on it.
26:45It's kind of crazy.
26:46I'm just trying to hold pressure here.
26:48Are you able to hold pressure on that spot while I do this?
26:52I mean, these tumors are kind of ass .
26:54Like they just, they bleed.
26:55They're not predictable.
26:57And when you cut through them with a knife, they kind of scored out.
27:00So at some point, we see these dark squirts of what look like squid ink coming out.
27:05And that's just old pools of collected blood that have accumulated in the tumor.
27:09Let's get a fresh one of these guys.
27:11Just keep them coming.
27:12Some of this, we can't even keep up with.
27:14It dribbles onto the drapes and dribbles onto the floor.
27:16Give some fresh slaps.
27:18Keep them coming.
27:19Keep them coming.
27:19Right here, right here.
27:20We're soaking up rags, basically.
27:23There's an element of how much blood have we lost?
27:26Should we stop?
27:27Is constantly on my mind when we're doing that.
27:29Do you want me to hold that?
27:30Maybe you work this way or up that way?
27:32This is not going to be that easy.
27:34I'm really trying to get as much of the tumor out.
27:36It's basically racing against blood loss.
27:38This is a challenge.
27:39If we can't get control of it, then we've got to stop.
27:41That's it.
27:53It's a nice bleeder there.
27:54You just have to put pressure down here.
27:56And let me work up top.
27:57That's sort of the best way to do it.
27:59Trey's tumor basically starts in the front of his face,
28:02extending onto the scalp and towards the back of the head.
28:05And we're getting rid of a lot of this tumor.
28:07But this level of bleeding is obviously not a good sign.
28:10What else are you trying to take out?
28:11And I just sort of do a back cut across here.
28:13Give me a knife, please.
28:14Yep.
28:14I like to operate fast when I see this
28:16so that we get enough of it out.
28:18And get this all closed up quickly.
28:21Now it's a race against time.
28:22At the rate that this tumor is bleeding,
28:24we're going to take out as much as we can and close him
28:27before we get into a life-threatening situation.
28:29It's going to go fast.
28:31That's what you got to do.
28:32Doesn't make sense, but hey.
28:35Move, move, move.
28:36I'm waiting for Trey.
28:40Not exactly sure what's going on in there, but a little worried.
28:45Obviously, anytime someone's getting cut open,
28:47it's a little bit of a scary thing to go through.
28:49This one's coming out.
28:50Trey deserves this more than anybody I know,
28:56just simply because of the type of effort he puts into other people.
28:59Yeah, keep grabbing that flap on your side.
29:01For once in his life, he's getting something done for him
29:04that is just going to change everything for him.
29:07Where his confidence is consistent all the way through his days,
29:10and he doesn't have to wake up feeling certain types of emotions
29:13because of something he can't control.
29:16Let's get this out of here.
29:18Another piece coming out of here.
29:20This will be the last part of this area here.
29:22Another piece.
29:24It's a lot of bleeding.
29:26So chances are we don't do the front.
29:30It's just going to keep bleeding.
29:31Now I'm reaching the top of the ear,
29:32and we've already lost a lot of blood.
29:35And trying to remove more tumor is just going to be
29:37life-threatening at that point.
29:38It's already got a good chunk of it out.
29:41So at that point, I'm going to stop.
29:44We are definitely not going to be able to get all of this out today.
29:47Now, let's get ready with the stitching.
29:53We still got a lot out for sure.
29:55Yeah.
29:56Go ahead and weigh that out and see how it looks.
29:59327 grand.
30:01I mean, it's almost a pound.
30:03Oh, yeah.
30:03That's not nothing.
30:05I'm feeling really good about it.
30:06We were able to remove a lot of tumor.
30:09She's got a neck now.
30:10That's good.
30:11Yeah.
30:11So what we have left to do is taking out the rest of the tumor in front
30:15and correct the position of the ear with the next stage of surgery,
30:18moving forward in the next several months.
30:20Well, it was a journey.
30:22Not bad.
30:24All right.
30:24All right.
30:25Very good.
30:25Very good.
30:27I'm nervous.
30:41Yeah.
30:42Yeah.
30:43Are you nervous?
30:44No.
30:45I feel like I'm the only one that's nervous.
30:47It's like I don't know what I'm going to see when I wake up.
30:52I'm pretty nervous about surgery.
30:54I mean, I haven't had a major surgery since I was a kid.
30:58And it's scary going into a second surgery as a fully aware adult, you know,
31:05knowing there's always going to be risk.
31:07I'm really putting my life in the hands of Dr. Ravello.
31:15I'm glad you're here.
31:22Hello.
31:23Hey.
31:24How are you?
31:24I'm good.
31:25I'm okay.
31:26Are you ready?
31:27I am ready.
31:28Okay.
31:28I am ready.
31:29All right.
31:29Good.
31:30We're going to really focus on that outer part of the lip.
31:34If we can get some more from inside the mouth, then we will.
31:37That sounds great.
31:38Yeah.
31:38Are you ready to be gone?
31:39I'm ready.
31:40Yeah.
31:40Yeah.
31:41All right.
31:41Well, I'm excited.
31:42Me too.
31:43Good.
31:43All right.
31:44All right.
31:44Let's do it.
31:44We'll see you back there shortly.
31:46Okay?
31:46Okay.
31:46I trust Dr. Ravello 100%.
31:49I just feel really safe and comfortable with her.
31:52I feel like I'm in good hands.
31:58Oh my goodness.
32:06The surgical plan today for Ambie is the removal of her vascular malformation on the side of her mouth.
32:13The hardest part is going to be reconstructing the corner of her mouth.
32:17The corner of the mouth plays a huge functional role in how the mouth works.
32:21If it's not working properly, you can have liquids drip down.
32:25You could have fluids escape.
32:26It might be hard to chew really well.
32:28That corner of the mouth is super critical in how the whole mouth functions.
32:38Look at that.
32:39When you push into it, it's like a sponge.
32:41You go like that.
32:43Watch it fill up.
32:44It comes back.
32:45Isn't that cool?
32:46That is very cool.
32:47That's a classic root of malformation.
32:50Dr. Panossian is going to be assisting me today.
32:52And having an extra surgeon in the OR with you, someone that can bring a different eye or a
32:57different opinion to the table, is incredibly helpful.
33:00Incision.
33:08My concern is how much of this I can remove while still leaving her with a functional corner of the
33:16mouth.
33:16The deeper this goes and the more involved it is, the closer we're getting to those more critical
33:21aspects of the face, like the nerves.
33:24Right there.
33:27Now you're definitely looking more spongy there.
33:29Yeah, it's like little pockets of normal in between.
33:32Yeah.
33:33You don't have any wiggle room to keep cutting out on the face because you're going to start
33:39just figuring vital parts of the face.
33:41You can probably do something like...
33:43Yeah.
33:44Do you think that's reasonable?
33:49After getting through the initial layers of the malformation, I'm able to remove the superficial
33:55part of it.
34:03That's a big goomba right there.
34:05Mm-hmm.
34:07Removing this vascular malformation was not easy, but it was the simplest part of this whole procedure.
34:13Now what we have to look at is how are we going to reconstruct this corner now that we do have
34:18this large defect.
34:19Yeah.
34:20Right there.
34:22So the next step is putting the muscles back into approximation.
34:26That's the critical part of closing the corner of her mouth.
34:28That's just begging to come over.
34:31It's not just stitching one edge of skin to the other.
34:34We actually have to orient the muscles underneath in such a way that it creates a sharp corner.
34:39If we don't get these muscles on the right tension, in the right direction, in the right amount of
34:46closure, then the corner of the mouth might not look good or it might not function well.
34:50This is the most critical part of the surgery, so we have to proceed very carefully.
34:55Otherwise, Ambie could be left with a huge hole in her cheek.
35:00We do have some good uninvolved muscle here, which is really helpful.
35:15That's not bad.
35:15I would probably use it as a handle.
35:17This is the most critical part of the surgery because the muscle that goes around the lips
35:23goes all the way around it.
35:24And when it functions, it contracts down, it opens up, and it allows the mouth to open and to move.
35:31If you have a break or a scar or some kind of trauma to one area, well, now it can't do anything
35:38because it's not in continuity.
35:39We have two options.
35:41The first one is to just close it and leave behind the majority of the malformation.
35:45The other option is to take more of that malformation.
35:49But I need to really sort of play with how much movement I have and how short her lip's going
35:55to be if I take out all of that tissue.
35:58I'm pretty happy with how much we've removed.
36:02I mean, that's it.
36:04Because this will be the new corner.
36:07So if this is the new corner, you can kind of guide the muscle.
36:12Yeah, that was good.
36:13You want that?
36:14Yeah.
36:14Yeah.
36:15We've made a decision on how to reconstruct this corner.
36:19The next step is to get a seat chair, and then we're going to put this lip back together.
36:22We have to be precise about how we put the corner of the mouth back together
36:27so that we maintain as normal function as possible.
36:32Middles is doing a beautiful job on this lip.
36:35It was a big relief when we saw it all come together, and the symmetry was good,
36:39and we didn't shorten the mouth too much, and so it was a big win.
36:44We are all done.
36:45The case went beautifully.
36:46So the external portion of that malformation is now gone.
36:50She just has a nice scar, which is going to heal really well.
36:52This incision here, that's where the external malformation used to be.
36:58So that's what was removed.
37:00Underneath that, there's another layer of sutures that put her muscle back together,
37:04and then below that is another row of sutures.
37:06But you don't see those.
37:07The only ones that you see is his nice row on the top.
37:10And I'm really excited.
37:10I think this is going to be really good for her.
37:12Good job.
37:13High five.
37:13High five.
37:26I'm following up with Ambie today.
37:28She sent in some photos for us to review.
37:31When Ambie came in, she had a residual vascular malformation on the corner of her right lip.
37:36I'm really looking forward to seeing how she's healing up.
37:40When I'm looking at her photos, I can tell immediately that that very obvious vascular
37:47malformation is gone.
37:49The corner of the mouth looks great.
37:51The scar that's in that area has healed really well.
37:55I'm also looking to make sure that she's able to open and close her mouth,
37:58that we didn't make it too small, and that she can still open wide,
38:02do all the things that she was doing before.
38:05I'm very happy with the final result.
38:07I think we were able to keep Ambie looking just like Ambie,
38:10but without this vascular malformation that was causing her problems.
38:13The malformation should not come back.
38:15These usually tend to grow in their early childhood years and then stop.
38:19Ambie's done with surgery.
38:20She should not need anything more after this.
38:33Trey's coming in for his follow-up today.
38:45We had a lot of bleeding with Trey's first surgery, so we had to stop.
38:48For Trey's second surgery, we tackled the second part of that tumor, which extended onto his face,
38:54and we got the majority of that out. So what I hope to see today is better symmetry of the face,
39:00a better positioned ear, and I'm really anxious to see how he's doing.
39:05Hey!
39:06How you doing?
39:07How are you? You look great!
39:09Yeah, no, I feel great.
39:10Do you?
39:11Yeah.
39:11Awesome!
39:12And I can see a lot better. If I look up to the left, I can see better and all that.
39:16There's no hooding over my eye.
39:18Yeah.
39:19Going back to work, everybody's like, you look different. I was like, yeah.
39:24I'm looking at your ear position. It's much better.
39:27That's like the biggest difference I've noticed. My ears are actually symmetrical.
39:30When I put glasses on, they feel like they're actually lining up with my ear.
39:34They're sitting in the right spot.
39:35That's great. And this contour is really neat back here.
39:38It's really smoothed out. It's showing the back of the head a little bit nicer.
39:42Yeah, that's the biggest thing for me. Over time, it used to be down here,
39:46I couldn't feel anything. But now it's just like, I'm slowly getting sensation back throughout here.
39:50Yeah, yeah. No, that's fantastic. I'm ecstatic to have the majority of that tumor removed.
39:56Is there any chance that it will grow back and how fast it will grow back?
39:59There is still a chance that this grows.
40:00Will it grow back to like the extent it was before?
40:03No, that's the nice thing. So if it were to grow back, it never comes back in that previous form.
40:09You're doing great from what I can tell so far.
40:11Overall, I'm just very happy with the results and I'm truly thankful for you.
40:14Well, I appreciate that. I appreciate it. I'm so happy for you.
40:27All right, guys. Our patient Trey Matlock sent us a video.
40:30I want to show it to you. And this is what he sent us.
40:35What's going on, Dr. P? I just want to give you a quick update on how everything's going.
40:40Recovery's going well. I'm back at work.
40:42Look at this guy.
40:43Look at that.
40:44Family, healing is amazing.
40:46Oh, my gosh.
40:47Oh, wow.
40:48I'm a logistic truck driver.
40:50Wow.
40:50I deliver all over the state of Colorado.
40:52Before having surgery, I really didn't like interacting with people.
40:56Now, the best thing about my job is I can actually enjoy conversations.
41:01The worst part, I'm always in traffic.
41:03I want to go, I just want to thank you for helping me through this journey.
41:09And I can't wait to see what the future holds for me.
41:12Oh, wow. He looks great.
41:14Wow. Yeah.
41:15Trey was a wonderful guy even before surgery, but he's sort of an avoider of situations.
41:20Shy personality.
41:21He just seems so happy to be going in and like interacting with other people.
41:24I mean, that smile says it all.
41:26So great.
41:26My goodness, that was a bright smile.
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