Surgery Went Well

Sorry it has taken so long to update after surgery. Everything went well. Abby was taken back just after 8:30. Surgery started just before 1:30. It took anesthesia almost two hours to get everything set up. Once they got her sedated, she had to get a new central line that went in through her femoral vein, two more IVs in her feet and arterial line in her arm. The new IVs were to be able to give her lots of blood and fluids quickly in case she started losing a lot of blood from her carotid artery being hit (which didn't happen).

Around 1:00, Dr. Richter (the ENT) came out and said that the tumor had been removed up to her skull base with negative margins. They were waiting on pathology on a piece from her jaw to see if there were any cancer cells in it before removing any of the jaw. At that point, she had lost part of the nerve to her right cheek, but it was already mostly gone before surgery because of the tumor. She also lost the nerve to her right lower lip, but the nerve to her tongue had been preserved.

About 3:30, neurosurgery finished their portion. They cut about a half dollar size piece of skull removed while they did the work. The tumor had made a small hole in the base of the skull much larger. The entire infratemporal portion of the tumor was removed. The neurosurgeon cleaned out hole that had been worn and drilled some holes in the base of the skull to make it easier to attach the flap for reconstruction. Unfortunately, she lost her V3 nerve so she lost all sensation to her right cheek, right lower lip and right side of the tongue. They felt there was too great of a risk of cancer cells remaining in this nerve because it was the one that was the pathway from the lower face up into her skull.

After neurosurgery finished, the ENTs returned to do a little more work. They ended up removing about 1/4 of her jaw because there were a few cancer cells in the sample and because it was so damaged already from the tumor and most of its blood supply had been damaged.

Reconstruction began about 4:30pm and ended around 11 pm. They ended up using muscle and skin from her belly to do the reconstruction. It took a little longer than planned because the carotid artery and jugular vein were used as the flap's blood supply and both were damaged by radiation, which made it more difficult to connect them. She ended up losing a lot of tissue around her epiglottis, so she will have more swallowing problems for awhile, extending the need for a trach until she successfully learns how to swallow again with no aspiration. They decided to hold off on reconstructing her jaw with bone for a year or two. There were several reasons for this.

According to the surgeons, her 5-year survival prognosis improved immensely today and they feel that any remaining microscopic pieces will be successfully treated with chemo and she will live a long cancer-free life.

We were finally able to see Abby a little after midnight. She looked well considering what she had just gone through. She had several hundred stitches and is swollen, but she is not huge and has very little bruising with the exception of a black eye. The biggest shock to us was the incision in her belly. She lost half of her abdominal muscles, so she only has a 3-pack instead of a 6-pack (doctor's words). Her belly incision is approximately twelve inches long and her belly button was moved over to the point that it is almost in line with her right nipple, but that should be something that is easily fixed in the future.

She has been doing well since surgery. She has been sedated the entire time since surgery but has woken up several times to the point of answering yes and no questions and pointing to the door. For the most part, they have been successful at keeping her asleep, which is good. I'll try to update sooner whenever something significant happens.