- 6 minutes ago
Category
🎥
Short filmTranscript
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.
00:48It'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.
00:58Hello.
01:03Oh, 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?
01:12Okay, so I have a patient coming in.
01:15His name is Trey Matlock.
01:17And he's got tumors.
01:18And these tumors can be massive.
01:22Trey's case is a condition called neurofibromatosis.
01:25And, you know, I deal with this condition a lot.
01:28I specialize in it.
01:29And when it happens on your face, it's pretty noticeable.
01:32It's almost impossible to hide.
01:35It sort of distorts the half of his face.
01:38It goes across the scalp area.
01:41And it actually dives down along his hairline in the back.
01:45It's almost like it gives you the impression that it's hanging.
01:47Yeah, it's like 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.
01:55Almost looks like a boxing match to me.
01:57I mean, yeah.
01:57His ear's actually a little bit lower and almost even tilted back.
02:02We want like, what, a 20-degree tilt?
02:03And 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.
02:16I'm talking about life-threatening bleeding.
02:18I mean, it's already a very vascular area.
02:20I mean, people can literally bleed to death from the scalp if you don't get it closed.
02:25I can tell you that a lot of people try and they aborted the surgery because it was too much bleeding.
02:31And 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, so...
02:40All right, we'll do it.
02:44I 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.
02:55One 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.
03:04Every day, I get a sharp pain on the side of my head.
03:15I was born a normal baby, but over time, the tumor started to grow.
03:23I first noticed I was different in elementary school because I tried to play sports like football.
03:31And 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.
03:41But I really couldn't play because of my condition.
03:48I 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 and it sits lower than my other ear.
04:00When I look in the mirror, my biggest fear is that the tumor will get bigger and eventually just grow and grow.
04:11I 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.
04:22It's good to see you, bro.
04:23Always.
04:23Good, man.
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. I feel more comfortable with him than anybody else.
04:38He really brings me out of my shell. Like, he doesn't let me get inside of my own head.
04:43He 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.
04:51Good.
04:52Probably going to be gouging us for the tickets, though.
04:54For sure, bro. Like, I'm trying to keep my mind occupied, not really, like,
04:58thinking about going, like, going out there, but at the same time, like,
05:01my mind's been racing about going out there.
05:03Right.
05:03The plan is to fly to Los Angeles and meet with Dr. Parnozian.
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.
05:21Like, 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 and start.
05:28Yeah, and I see that, too.
05:29Yeah.
05:30Obviously, 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,
05:37it was more of who he was as a person.
05:40His 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.
05:52It'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.
06:02The 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.
06:12Just hang out inside and not be around people.
06:18Just never be seen again.
06:19I'm going out to L.A. soon, man.
06:21I'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?
06:38So 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.
06:50You 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. Panosian 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.
07:02Mm-hmm.
07:12Hello.
07:13Hi.
07:13Want to see you Dr. Panosian?
07:14Perfect.
07:15If you could sign in.
07:16My 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 in here and do this.
08:12Hello.
08:12How are you doing, sir?
08:13Hey, how's it going?
08:14Good, all right.
08:14How are you?
08:15Great.
08:15I'm Dr. Panosian.
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.
08:24Are you going to come out?
08:25Absolutely.
08:25I 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 been passed down for me from my mother, who 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.
09:02I'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. Is it kind of heavy?
09:17Oh, yeah.
09:17It's got some weight to it.
09:18Yeah, I can feel the weight.
09:19So, like, 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.
09:55Shoot.
09:56It's a lot of bleeding.
09:58These dark pools of what looked like squidding kind of scored out.
10:01Keep them coming. Keep them coming.
10:02Now, it's a race against time before we get into a life-threatening situation.
10:06Move, move, move.
10:13Now, 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.
10:26And it's sort of dropped down.
10:27And it's also kicked out a little bit.
10:29It looks like you have what we call a plexiform neurofibroma.
10:33Basically, 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.
11:07This is really exciting for me to 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 is removed and much of it's gone,
11:33I'm going to reposition the ear, anchor 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.
11:56It's really helpful when we have this technology because we can then, in real time, show the
12:02different problems from different perspectives, which helps people understand not only the severity
12:08of 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, that 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.
12:36The tumor is 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.
12:46And 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.
12:56And if it bleeds way too much, we have to stop.
12:59Okay.
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. Pronosian 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 much
13:52and 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.
14:04Excellent.
14:05Thank you, sir.
14:05Much appreciated.
14:06Excellent.
14:06Great to meet you guys.
14:08All right.
14:08See you soon.
14:09So I have a patient coming in today.
14:21Her name is Ambie.
14:22And Ambie was born with a vascular birthmark or a vascular malformation of 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 could be a
14:41more extensive involvement inside the mouth as well. I may not be able to take the whole thing out
14:46because it would just leave a giant hole at the corner 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. Being bullied and called names.
15:05Every single interaction is a reminder that I'm different.
15:15Me first?
15:15Yep.
15:16Age over beauty?
15:17I 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.
15:33No way.
15:34Yes!
15:34Did it go in?
15:36It went in. Yeah, it did.
15:38You 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. I had surgery when I was five where they took out a good
15:52portion of it. And then between then through my teenage years, we tried a laser treatment. We did a
16:00couple saline injections to try and shrink it. And at that point, they had told me there really wasn't
16:06much more that could be done. I had kind of reserved myself to believing, like, this is, this is it.
16:13Oh my goodness. Did you have fun?
16:16Yeah, it was awesome.
16:17Yeah.
16:18So are you ready?
16:21How's it going to feel having surgery now?
16:23I think I felt very discouraged after that last consult. He was just very adamant, like,
16:31there's really nothing more we can do. I think there was, like, a part of me that was, like,
16:37scared to inquire for the fear that the answer would still be no.
16:41Yeah.
16:41A big reason for wanting surgery was just so I didn't have to, like, worry about, you know,
16:49having it bleed. It can bleed very easily. If I eat something sharp, if my dog nips at me in the
16:56wrong spot, it bleeds and it doesn't stop until the skin is healed. And the skin can't heal so long as
17:03I'm talking or moving my mouth. It's just very exposed and vulnerable.
17:08So 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. I think it'll be a
17:19burden off. You 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 LA and meet with Dr. Ravello and she's going to let me know
17:30if there's anything she can do for me. I'm excited. I'm excited. I'm nervous.
17:36I'm going to miss my little buddy.
17:37Yeah. You little weirdo.
17:40Hi. Hi. Welcome. Are you here to see Dr. Ravello?
17:50Great.
17:55I get people saying, what is that on her face? Why doesn't she get that taken care of?
18:01Go ahead and take a seat. My doctor will be with you shortly.
18:03Thank you. It's exhausting and it does hurt when it's pointed out to you your whole life that it's
18:09different. Oh my goodness. Hello, hello. Hi. How are you? I'm good. How are you?
18:19Very good. Good to see you. Yeah, good to see you too. Andy, Josh. Hi. Josh. Josh is...
18:26Partner. Partner. You know, I always ask. I have to clarify because I've made some mistakes.
18:30Oh, you brought your mom with you. Oh my God. Oh, that's my wife.
18:35Well, how are you feeling today? I feel good. I feel excited.
18:38Good, good, good. Yeah, yeah. If you don't mind, let's take the mask off. Let's do it.
18:51And let's talk a little bit about why you're here. What'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. I kind of just accepted that
19:10reality and lived my life. So, how old were you when you first had a surgery for this?
19:17I was five. You were five years old. I was five, yeah. Okay. And after they did the first surgery,
19:23was that malformation completely gone or did you still have some left behind?
19:27There was definitely some left behind. That small part that was left continued to grow as I grew.
19:34Got it. This is going to definitely keep growing and could become a huge problem. We have to address this.
19:41Well, with that in mind, may I take a look? Let's do it. Okay. Does any of this hurt?
19:47Does it hurt when it's touched? Not at all, no. Okay. And close your mouth here.
19:53So, what I can see here, you have this scar from your previous resection that comes down vertically
20:00this way. Then open a little bit. And then on the outside, you have this kind of conglomeration
20:07of abnormal blood vessels coming out the corner of the mouth. And then open again. It continues
20:14around to the inside for a couple centimeters. And so it's really almost kind of like this wrapping
20:21around the corner of your mouth. And then open all the way. Okay.
20:26Ambie's malformation is in a very tricky area. The external part involves the corner of the lip
20:33and then on the inside, it's pretty large. I mean, it's definitely a couple inches at least.
20:39That means that I can't remove the whole thing. I can't take out this entire
20:43malformation because it would be half of her cheek. This definitely makes things much more challenging.
20:53This program examines medical conditions and the procedures involved with treating them. Due to their
20:57graphic nature, viewer discretion is advised. And then close your mouth and do like a whistle-blowing
21:04move. Yeah. And go like this. Yeah. So you have really good muscle. The muscle is retained and strong.
21:13You have a strong mouth. So when I was examining Ambie, I noticed that the external part of this
21:20malformation actually curves around and then extends into the inside of the cheek. This may not be the largest
21:29malformation, but its location makes it very tricky and complicated to treat. So I'm sure you know or you've
21:35been told before that this is a hemangioma. A hemangioma is a collection of abnormal blood vessels.
21:42You're born with it. The problem with yours specifically is the location. That corner of the lip
21:48has a very vital function to the lip. Right. It controls a lot of the movements of it. The other
21:53concern is that it goes all the way around and is through and through. Yeah. So it's going through
21:59all the layers of the lip. That's the inner lining, which is the mucosa, the muscle, as well as the skin
22:05on the outside. Okay. That side of the lip is already a little bit shorter than the other side. Yeah. And
22:11further surgery to remove that area could shorten it a little bit more as well. Yeah. So
22:17treating it is not as straightforward as it may look. You can't just cut it out and sew it back
22:23together and call it a day. Right. And that's because it involves so much of that critical part
22:28of the mouth. I do think it is possible though to remove it or perhaps only one part of it. Since
22:35the outside is the part that we can see, I think we can definitely start by addressing the outside part
22:41first. Yeah. Does it sound like something you might want to do? Yeah. Yeah. Let's do it. Yeah.
22:46Okay. Good. All right. Let's do it. All right. My concern about this surgery is how much of a normal
22:55lip I'm going to be left with once we remove this vascular malformation. We have to be pretty precise
23:02about how you remove it. If you go in there and you start cutting away muscle,
23:06now you've actually lost the function of the lip.
23:20it's finally here. The day is here. I'm a little nervous to be honest with you. I'm like a little
23:32a little nervous for you and I can only imagine what you're going through. But yeah, man, just
23:35going with the punches, going with the flow. Hello. Hey, how are you guys? How you doing? You ready?
23:41Yes. Awesome. All right. This is it. Oh yeah. I'm ready. For 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. Oh yeah. I'm hoping
23:53for the best. Yeah. And I got anything you can do for me. It's amazing. What are you going to do
23:57in the meantime? Sunday football, man. I'm going to watch some football, right? I'll wait around.
24:01Let's get in there and get this done. Okay. Thanks, sir. All right. Good.
24:04Good. That made me feel a lot better too. Like just him being relaxed, joking around. It's like,
24:11I'm more relaxed, more ready now. Yeah. It's game time. I'm ready.
24:18Today is Trey's surgery and nerve fibromatosis is one of my specialty areas surgically. So I,
24:24I deal with this a lot and they are challenging. All right. Okay. You can knock out the nerve. You can
24:31create some life-threatening bleeding. So we always have to think about how to approach the problem.
24:36All right. So we got our patient here, Trey. I think we just kind of dive in, scoop out as much
24:41of that as possible. Today, I'm helping out Dr. Panossian with Trey Matlock. This is a very
24:46impressive tumor. He has entire areas of his scalp that don't grow hair because it's completely covered
24:52and involved by the tumor. I'd like to get rid of all this stuff too. This stuff is... That'll make a big
24:57difference. Yeah. My plan for Trey today is to start with the tumor on the back. The nerves are
25:02not that important in that area. And it gives me a sense for how much bleeding I'm going to encounter.
25:08Incision. Start with a little something like this.
25:18And you can kind of tell it's already looking kind of amorphous. That's what these things look like
25:22right here. It's kind of little forms of grapes and worms. That's kind of what it looks like.
25:28Look at that. It's like gray in there. It's definitely not normal. Yeah. See that? Look at that.
25:32That's the grayish, junky tissue. That's tumor. It's crazy. Look at that. It's like ink. It's like
25:37octopus ink. I was going to say, it looks like squid ink. These tumors got multiple colors and tones to it.
25:43Texture is different. All of it's almost gelatinous in terms of what you're touching. It's like
25:48jelly almost. And some of it is the tumor. Some 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. And 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 got a big giant piece. Quickly go through the stuff here.
26:06And we'll just take out more tumor from underneath it. It's a big old deal.
26:12Chicken dinner. We just got rid of a lot of this tumor, but it's huge. There's still a lot of tumor
26:18left that I got to go after. Give me a knife again, please. Shoot. So yeah, we're getting a bunch of
26:27bleeding right now. And I think that that's sort of characteristic of these tumors. And this is what
26:31scares a lot of people to approach this from the surgical side. But I think it looks like this is a
26:37bleeder. That's a high flow. That's a high flow. Now this tumor is going. It's bleeding. And there's
26:43no way to stop it other than just put a hand on it. It's kind of crazy. I'm just trying to hold
26:47pressure here. Are you able to hold pressure on that spot while I do this? I mean, these tumors are
26:53kind of ass . Like they just, they bleed. They're not predictable. And when you cut through them with
26:58a knife, they kind of squirt out. So at some point, we see these dark squirts of what look like squid ink
27:04coming out. And that's just old pools of collected blood that have accumulated in the tumor.
27:09Let's get a fresh one of these guys. Just keep them coming. Some of this,
27:12we can't even keep up with. It dribbles onto the drapes and dribbles onto the floor.
27:16Give some fresh laps. Keep them coming. Keep them coming.
27:20We're soaking up rags, basically. There's an element of how much blood have we lost? Should we stop?
27:27It's constantly on my mind when we're doing that. Do you want me to hold that? Maybe you work this way
27:31or up that way? This is not going to be that easy. I'm really trying to get as much of the tumor
27:36out. It's basically racing against blood loss. This is a challenge. If we can't get control of it,
27:40then you've got to stop. That's it.
27:53It's a nice bleeder there. Let me just have you put pressure down here and let me work up top.
27:57That's sort of the best way to do it. Trey's tumor basically starts in the front of his face,
28:02extending onto the scalp and towards the back of the head. And we're getting rid of a lot of this
28:07tumor. But this level of bleeding is obviously not a good sign. What else are you trying to take out?
28:11I'm going to just sort of do a back cut across here. Give me a knife, please. I like to operate
28:15fast when I see this so that we get enough of it out and get this all closed up quickly.
28:20Now it's a race against time. At the rate that this tumor is bleeding, we're going to take out as much
28:25as we can and close him before we get into a life-threatening situation.
28:29It's going to go fast. That's what you got to do. Doesn't make sense, but hey. Move, move, move.
28:39I'm waiting for Trey. Not exactly sure what's going on in there, but a little worried. Obviously,
28:45anytime someone's getting cut open, it's a little bit of a scary thing to go through.
28:49This one's coming out. Trey deserves this more than anybody I know, just simply because of the
28:57type of effort he puts into other people. Keep grabbing that flap on your side.
29:01For once in his life, he's getting something done for him that is just going to change everything for
29:06him, where his confidence is consistent all the way through his days, and he doesn't have to wake up
29:11feeling certain types of emotions because of something he can't control.
29:14Okay, let's get this out of here. Another piece coming out of here. This will be the last part of
29:21this area here. Another piece. It's a lot of bleeding. So chances are we don't do the front.
29:30It's just going to keep bleeding. Now I'm reaching the top of the ear, and we've already lost a lot
29:34of blood, and trying to remove more tumor is just going to be life-threatening at that point.
29:38It's already got a good chunk of it out. So at that point, I'm going to stop.
29:43We are definitely not going to be able to get all of this out today.
29:47Now, let's get ready with them stitching.
29:53We still got a lot out, for sure.
29:55Yeah. Go ahead and weigh that out and see how it looks.
29:59327 grand.
30:01I mean, it's almost a pound. That's not nothing.
30:04I'm feeling really good about it. We were able to remove a lot of tumor.
30:08It's got a neck now. That's good.
30:12So what we have left to do is taking out the rest of the tumor in front and correct the position of
30:16the ear with the next stage of surgery moving forward in the next several months.
30:20Well, it was a journey. Not bad. All right.
30:24All right. All right. Very good.
30:41I'm nervous.
30:41Yeah.
30:42Yeah.
30:44Are you nervous?
30:44No.
30:45I feel like I'm the only one that's nervous. It's like, I don't know what I'm going to see when I wake up.
30:52I'm pretty nervous about surgery. I 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. I'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. Good.
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 a hundred percent.
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 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 classic root of malformation.
32:50Dr. Panosian is going to be assisting me today.
32:52And having an extra surgeon in the OR with you,
32:54someone that can bring a different eye or a different opinion to the table,
32:58is incredibly helpful.
33:00Incision.
33:01My concern is how much of this I can remove while still leaving her
33:14with a functional corner of the mouth.
33:16The deeper this goes and the more involved it is,
33:19the closer we're getting to those more critical aspects 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,
33:38because you're going to start disfiguring vital parts of the face.
33:41You can probably do something like...
33:49After getting through the initial layers of the malformation,
33:53I'm able to remove the superficial part of it.
33:59Yeah, that's her big goomba right there.
34:05Mm-hmm.
34:07Removing this vascular malformation was not easy,
34:10but it was the simplest part of this whole procedure.
34:13Now what we have to look at is how are we going to reconstruct
34:16this corner now that we do have this 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,
34:44in the right amount of closure, then the corner of the mouth might not look good,
34:49or it might not function well.
34:50This is the most critical part of the surgery, so we have to proceed very carefully.
34:56Otherwise, 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.
35:18This 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 kind of checks down, it opens up,
35:28and allows the mouth to open and to move.
35:30If you have a break or a scar or some kind of trauma to one area,
35:36well, now it can't do anything because it's not in continuity.
35:39We have two options.
35:40The 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
35:54and how short her lip's going to be if I take out all of that tissue.
35:58I'm pretty happy with how much we've removed.
36:01I mean, that's it.
36:03That'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.
36:12You want that?
36:13Yeah.
36:15We've made a decision on how to reconstruct this corner.
36:19The next step is to get a seatbelt, 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.
36:32Middleton is doing a beautiful job on this lip.
36:34It 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.
36:43We 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.
36:53This 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 this 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.
37:22High 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.
37:42When I'm looking at her photos, I can tell immediately that that very obvious vascular
37:47malformation is gone.
37:49Corner 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.
38:34Trey'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.
38:49For 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.
38:56So what I hope to see today is better symmetry of the face, a better positioned ear,
39:01and I'm really anxious to see how he's doing.
39:05Hey!
39:06How you doing?
39:07How are you?
39:08You look great!
39:09Yeah, I know.
39:09I feel great.
39:10Do you?
39:11Yeah.
39:11Awesome!
39:12And I can see a lot better.
39:14If 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,
39:20you look different.
39:21I was like, yeah.
39:24I'm looking at your ear position.
39:26It's much better.
39:27That's the biggest difference I've noticed.
39:29My 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.
39:36And this contour is really neat back here.
39:38It's really smoothed out.
39:39It's showing the back of the head a little bit nicer.
39:42Yeah, that's the biggest thing for me.
39:44Over time, it used to be down here, I couldn't feel anything.
39:47But now it's just like, I'm slowly getting sensation back throughout here.
39:50Yeah.
39:50Yeah, no, that's fantastic.
39:52I'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 the extent it was before?
40:03No, that's the nice thing.
40:04So 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.
40:16I appreciate it.
40:16I'm so happy for you.
40:17All right, guys, our patient Trey Matlock sent us a video.
40:30I want to show it to you.
40:31And this is what he sent us.
40:33What's going on, Dr. P?
40:37I just want to give you a quick update on how everything's going.
40:40Recovery's going well.
40:41I'm back at work.
40:42Look at this guy.
40:43He's a little bit of a man.
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.
41:06I 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.
41:13He looks great.
41:14Yeah.
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.
41:26Oh, my goodness.
41:27That was a bright smile.
Recommended
36:37
|
Up next
55:06
59:14
55:03
22:36
41:31
43:11
45:20
54:19
56:16
52:35
1:10:39
40:56
47:34
49:28
46:47
49:04
47:34
44:03
58:53
Be the first to comment