I've been digging through PubMed looking for an interesting photo to post and came across something that made me swallow hard. Initially, I thought it was a photo of a severely deformed infant. Then I read the article. The patient in question is a 19-year-old girl from Saudi Arabia with a huge maxillofacial tumor that recurred several times despite surgical intervention and chemo- and radiotherapy. It deformed her entire skull, displacing her eyes and mushrooming from her nose and mouth like some weird alien parasite.
Huge craniofacial tumor in a 19-year-old girl. Image from: Arab et al. (2014)
The tumor had invaded the pharynx and oral cavity, making it impossible for the patient to eat, so she was being fed through a gastrostomy. She weighed only 40 kg (around 88 pounds). Her airway was severely distorted by the growth: she was unable to breathe through the nose, and suffered from obstructive sleep apnea and shortness of breath. Her vision was also impaired, although amazingly, she was still able to see a little with one eye at least. The article describes how she was sedated for the placement of a tracheostomy in order to be able to breathe. Sedation was somewhat challenging since the patient was very afraid of pain and flatly refused IV cannulation (her veins were so sclerosed that inserting a cannula had become a difficult task), so a mixture of drugs was administered through the gastrostomy tube and an anesthetic cream was applied to the the planned tracheostomy site. The patient survived the operation and had no recall of the procedure afterwards. The article doesn't specify how long she lived after the tracheostomy; not long, I assume.
Stories like these just make you glad to be alive.
Arab AA, Almarakbi WA, Faden MS, Bahaziq WK (2014) Anesthesia for tracheostomy for huge maxillofacial tumor. Saudi J Anaesth. 2014 Jan-Mar; 8(1): 124–127.