Mt Vernon Cosmetic Surgeons Press
THROAT CANCER RECONSTRUCTION SURGERY REVOLUTION
A new technique for reconstructing the palate after surgery for tonsil cancer enabled patients to speak clearly and eat most foods, shows a new study.
The technique was developed at the University of Michigan Comprehensive Cancer Centre, by Douglas Chepeha, M.D., M.S.P.H., associate professor of otolaryngology head and neck surgery and director of the microvascular program. He said: “This is the area that triggers swallowing, that separates the mouth from the nasal cavity. It affects speech and eating – typically, patients have difficulty eating when they have this kind of tumour and undergo surgery. We can remove the cancer, but there are major quality of life issues.”
Tonsil cancer develops in the back of the throat, which means surgery could include parts of the palate, the tongue and the jaw. Traditional reconstruction efforts have meant taking a large, round piece of tissue to plug the hole left when the tumour is removed. But this impairs the way the palate and tongue function, and does not restore the complex components of the throat that allow a person to speak and swallow.
With the new technique, surgeons first create a tube which separates the mouth from the nasal cavity and closes during swallowing, allowing patients to eat and speak. Then the surgeons sew up the defect in the base of the tongue to separate the tongue from the rest of the reconstruction. This ensures that the tongue can move, which improves swallowing and speech. The shape of the remaining defect is irregular, so a template is designed for using transplanted tissue to fill in any other holes left by the surgery.
The study followed 25 patients with tonsil cancer. Patients were grouped based on how much of their palate was removed during surgery: less than half or more than half. The patients were followed for an average of five years after the surgery.
Both groups reported few problems with speech. Patients who had more than half their palate removed were more limited in what they could eat and reported some restrictions to eating out in public. Emotional scores were high for both groups, suggesting overall satisfaction with their lives.
“In particular, patients who have less than half their palate removed do very well with this reconstruction. We’re trying to make sure the remaining tongue and palate they have really work. Our goal is to get patients eating in public and back to work,” Chepeha says.
The number of tonsil cancers diagnosed has increased in recent years due to HPV, or human papillomavirus, the virus that is also linked to cervical cancer.
NHS SHOULD REFUSE ‘COWBOY COSMETIC SURGERY’ REMEDIES
The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has urged the NHS to treat patients suffering complications from surgery abroad only when they are in severe pain or have life-threatening conditions.
Anthony Armstrong, chair of BAPRAS’ clinical effectiveness committee, said: “Anyone considering surgery abroad must make sure they are fully aware of the potential complications that can occur and how they will be dealt with. They should not assume that the NHS will pick up the pieces and, they may find themselves having to pay privately for follow-up surgery here.”
According to Nigel Mercer, consultant plastic surgeon and President of the British Association of Aesthetic Plastic Surgeons (BAAPS), “There are calls for the NHS not to pick up the tab when problems result from cosmetic surgery ‘holidays’ so it’s essential that the public be educated about the options and risks.”
Douglas McGeorge, a past president of BAAPS, said people had to be aware of the risks and costs of surgery abroad. He said: “There are some very good surgeons abroad. What we have in this country is a system that is much more regulated than in Europe. Patients have to be able to know what they are getting for their money, and the qualifications of their surgeon.” The cost of revision surgery was often “significantly higher” than the original surgery, he said.
Mark Bury, chief executive officer of SurgiCare, one of the largest cosmetic surgery networks, said he had seen a surge in popularity for surgery abroad, but also a “huge increase in very unhappy people calling us, desperate to fix the mistakes cowboy surgeons abroad have made”. He added: “You get what you pay for and although going abroad for surgery can sometimes appear cheaper, access to important after-care solutions will not be available to the patient once they are back in the UK, and if something does go wrong when they are home, the patient will have to pay again for any corrective procedures.”
‘MAN BOOB’ SURGERY SOARS
Male breast reduction operations across the UK have increased by more than 1,000 per cent in five years. The figures were revealed by the British Association of Aesthetic Plastic Surgeons (BAAPS) at its conference in Cardiff. In 2003, it dealt with 22 such operations but there were 323 last year – including one teenage boy.
The increased number of gynecomastia operations – often referred to as “man boob” reductions, or a “moob job” – has been fuelled by middle-aged and elderly men wanting to bare their chests on holiday. There was a 44% rise in “moob jobs” between 2007 and 2008 and it pushed out the facelift to become the fifth most popular plastic surgery for men in Britain after nose operations, eyelifts, ear corrections and liposuction. More than 1,000 men in the UK have paid £2,000 for the operation in the last year. Plastic surgeon Fazel Fatah said: “Reasons for the upsurge include men being more open now about their physique than years ago and they can get more and more information about it from internet sites which encourage them to have the op.”
Douglas McGeorge, a past president of BAAPS, said the growing trend for “man boob” reductions was mostly middle-aged and elderly men, but that teenage boys were also having the operation. “I get people coming to me in their 50s and 60s. Men who have never taken their T-shirts off in public before,” he said. “We are seeing men of all ages coming in to have their breasts made smaller. They are losing their inhibitions about the operation and deciding to undergo an operation which previously was a women’s operation.”
Mr McGeorge, who is based in Chester, said one recent patient was “typical” of the men who are queuing up for breast reduction. He said: “It was a grandfather who had never taken off his T-shirt in his life because he was so embarrassed about the size of his breasts. He had never been able to strip to the waist on the beach in front of his own children – but was determined not to be in the same position with his grandchildren.”