Hitting the High Notes
Cliff’s waiting-room soiree ended abruptly when a receptionist led him down a long hospital corridor and through a door that would forever change his life.
The 13-year-old trombone player had a rare form of mouth cancer – so complex it would take an intricate team of specialists to remove and repair the damage. Cliff’s 30 friends and family members went from relaxing to praying, while doctors literally peeled back Cliff’s skin and permanently removed five teeth and a large portion of the roof of his mouth. The Health Science Center team was confident the procedure would work. But Cliff and his family weren’t exactly sure how his life would turn out.
Cliff’s ordeal began last July, with a routine visit to the dentist. "The lady cleaning my teeth noticed this purplish growth on the roof of my mouth. She kept saying ‘you can probably feel this with your tongue,’ but I couldn’t," Cliff said. "She called in the dentist and he kept poking me and finally referred me to another doctor."
Cliff had a biopsy and a CAT scan. "In the beginning we weren’t too worried. We thought everything was going to be okay," Cliff said. "I thought this was just something doctors could treat with antibiotics." It wasn’t.
A pathologist told Cliff he had a low-grade form of muco-epidermoid carcinoma, a rare cancer of the salivary glands that is uncommon in children. "I thought I was going to die," Cliff said. "We went through all the emotions, the crying, the getting scared."
But Dr. Miller wanted to take a seemingly bizarre approach called midface degloving. "We make an incision under the upper lip, along the gum line," Dr. Miller said. "Then we are able to lift the skin off the face and over the nose to expose the skeleton." The procedure leaves no visible scars, no bruising, and hardly any swelling.
While Dr. Miller constructed a plan to extract the tumor, Dr. Pigno began taking impressions of Cliff’s mouth. He was creating what is known as an obturator prosthesis. The plastic device resembles a retainer and is inserted before the patient awakes from surgery. "Its role is both functional and psychological," Dr. Pigno said. "The obturator prosthesis placed during the surgery is temporary and acts like a bandage that fills the defect so patients can’t feel the hole when they get out of surgery. It covers the defect during initial healing, protects the surgical site, and enables normal oral function."
As the patient heals, Dr. Pigno constructs a more permanent obturator prosthesis, which functions as a specialized type of denture.
"Without the obturator, Cliff wouldn’t be able to chew, swallow or speak well," Dr. Pigno said. "And the prosthesis is important for facial aesthetics because it replaces the teeth and gums that were removed as part of the cancer surgery."
Armed with a good plan and the best possible care, Cliff entered the surgical suite on Aug. 6. "I thought I was too young to die and I really trusted Dr. Miller," Cliff said. "But I was really scared to go." Two hours later, Cliff woke up a little sore and a little worried.
"The doctors told me I had a chance of playing the trombone again, but after feeling around my mouth with my tongue, I didn’t believe it," he said. He spent the next six days recovering and wondering what life would be like when he got out of the hospital.
"As soon as I got out of the hospital, I couldn’t wait to see if I could play the trombone," Cliff said. "With the trombone you have to ‘buzz’ your lips, so as soon as I got home I took off the mouthpiece and I tried it… nothing. But I kept trying, and pretty soon…" Cliff tooted on the mouthpiece. "I finally took out my rhythm sheet and started playing."
But Cliff still wasn’t a Glenn Miller. "When I first started playing, I didn’t have a good seal. The air would get in between my teeth and go out my nose," Cliff said. "It made kind of a bubbling sound."
Cliff went back to Dr. Pigno. "He worked on my obturator and kept working on it until it felt good," Cliff said. "Now it’s really comfortable. I don’t even notice it anymore."
And you wouldn’t notice it either. Cliff is a great-looking kid who seems like any other teenager. "This did change him a lot. He seems happier and so much more at ease," said Leticia Barrera, Cliff’s mother.
But most importantly, Cliff is healthy. "The chance he is cured is probably 90 percent and we’re very optimistic based on the pathology of his tumor," Dr. Miller said.
As for Drs. Miller and Pigno, they have both been elevated to "hero" status at the Wedgeworth’s. "My son really looks up to them," said Clifford Wedgeworth, Cliff’s dad. "When they first sent us to the Health Science Center, we were a little surprised. We didn’t know there were so many specialists there. But the whole Health Science Center experience was top of the line."
It should be. The Health Science Center cares for over 200 patients with head and neck tumors each year. Many of the cases require the multidisciplinary expertise only available at the university.
Cliff himself seems satisfied with the results. After missing three weeks of school and even more band practice, he secured first chair in the trombone section – a pretty high note, even for a teen who plays a tenor instrument.
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