In 2019, negorum, a 5-year-old girl from rural Ethiopia, was sent to a hospital in London for medical treatment. The giant tumor on her face extends from her cheek to her chin. The deformed blood vessels in the tumor are intertwined, threatening nigolam’s life. Doctors in London believe that the operation to remove the tumor is very risky, and negorum may not last until the end of the operation. After a more detailed diagnosis, the doctor told nigolam’s parents that surgeons in New York might be able to help.
The vascular birthmark Institute, located in New York City, is located on 64th street in Manhattan. Over the past three decades, the founder Milton Waner has focused on treating patients with hemangiomas and vascular malformations. Milton told Medscape, “I am the only surgeon in the United States who specializes in vascular abnormalities.”
In the Institute’s office at Lenox Hill Hospital in New York, Milton assembled a team of multidisciplinary medical experts, including his wife Teresa o. Wu is a facial plastic and reconstruction surgeon and an expert in neurology. “People always ask me why I’m with my wife every day,” Milton said. That’s because we cooperate and complement each other in our work“
Wu and Milton learned about negorum in January. After learning more about nikolam’s condition, they agreed to operate on her. They knew that there were few surgical teams around the world who could help the little girl. Children with vascular malformations are more difficult than adults because the amount of blood in children is much smaller than that in adults. The average blood volume of adults is 5 liters, while the average blood volume of children of the same age as nigolam is only 1 liter.
Milton said that if a 5-year-old child loses 200 ~ 300 ml of blood, “it is equivalent to 20% ~ 30% of the total blood volume in the body”. Negorum’s giant tumor resection requires a knife around many blood vessels. If she is careless, she is in danger of losing too much blood. Negorum experienced some twists and turns when she was admitted to the hospital, but she finally arrived in Manhattan in mid June this year. Her family doesn’t have to pay any fees for the whole journey.
Her medical visa was handled with the help of a volunteer working in the United States Agency for international development; The travel expenses shall be borne by the public welfare organization healing the children Northeast; The Waner Children Foundation paid for her accommodation in New York; Lennox Mountain hospital and northwell health bear all her hospitalization and postoperative care costs.
With the help of these organizations, negorum was finally successfully admitted to the hospital. However, there is little time left for Wu and Milton to prepare for the operation.
Before such surgery, patients usually need several rounds of sclerotherapy. During sclerotherapy, interventional radiologists inject a toxin into the patient to dredge the blood and reduce the risk of excessive blood loss during surgery. However, due to time constraints, negorum only received a round of sclerotherapy on the morning of the operation day, and the treatment effect is not ideal. “It’s because the tumor is too big,” Milton said
Milton’s team planned the surgery in advance, but the surgery was completely different from the cases in the textbook. Because of the particularity of surgery, Milton and Wu must give full play to their surgical skills. This patient is similar to the cases they face every day, but the magnitude is very different. “If you divide the case size into 1 to 10, nigolam is 12,” Milton said
On the morning of the operation, Milton felt very anxious. He still clearly remembered that the little girl’s father kept kissing her and saying goodbye to her lying on the operating table. Because he knew that the operation could take his daughter’s life.
The operation was difficult from the beginning.
First of all, the usual inhalation anesthesia cannot be used during anesthesia, because negorum’s lips have been squeezed and deformed by the tumor.
Secondly, abnormal tumors contain many important human tissues, such as jugular vein and carotid artery. Milton said that it is extremely difficult to separate these tissues without damaging them, and even a small scratch can have serious consequences due to the serious expansion of blood vessels.
At the same time, doctors realized that the tumor had spread to the mandible during the operation. “Some blood vessels have gone deep into the bones and are difficult to control,” Wu said
Therefore, the progress of the operation was very slow, and Milton and his team were careful at every step. Milton recalled, “at some stage of the operation, every time the scalpel moved one or two millimeters, there was a sudden outflow of blood.” Until the end of the operation, Milton and Wu realized that the operation was expected to be successful. After the tumor was removed, the two doctors began facial reconstruction and rehabilitation.
In order to withstand the expanding tumor, negorum’s mandible and cheekbones have exceeded the normal size. The two doctors had to cut her bones to make her face symmetrical. The tumor also inhibited the growth of nigolem’s facial nerve. After removing the tumor, Wu needs to find all the facial nerve branches and aggregate them together in order to restore the girl’s face.
Before entering the medical field, Wu studied architecture, so she has a keen perception of space, which is indispensable in the field of facial reconstruction. After listening to Milton’s lecture, she realized that her interests and professional skills had great potential in the field of plastic surgery and reconstruction. After that, she and Milton received specialist training in the field of vascular abnormalities, and has since specialized in facial nerve recovery surgery.
It was precisely because of Wu’s superb medical skills that negorum was able to show that new and beautiful smile after the operation. Negorum’s operation lasted eight hours, which was the workload of the two doctors combined with several operations a day. When Wu finally walked out of the operating room and was ready to convey the good news of the success of the operation to the girl’s family, the first sentence the girl’s father said to her was, “is my daughter still alive?”
Milton often said, “every child has the right to a normal face.” The tumor growing on negorum’s face affects not only the appearance. If the tumor is not removed, her life can only last for 4 ~ 6 years at most. The tumor may suffocate nigolam, may make her lose the ability to eat, or may put her life at risk from facial bleeding.
Wu and Milton insist that the treatment of facial abnormalities needs to adopt a multidisciplinary diagnosis and treatment model and comprehensively use interdisciplinary knowledge. Expertise in anesthesia, radiation, laser, facial nerve and so on is essential. Milton believes that the success of the operation is due to the close cooperation between team members.
After the operation, nigolam was finally able to live a normal life. The couple who presided over the operation were honored. Wu said, “I’m lucky to find what I’m good at. I’m lucky to work with Milton. I love my job. “