Head and Neck Surgery Is No Ordinary Occupation

emoving a cancerous tumor in the mouth requires delicate surgery, but that’s just the beginning for a head and neck specialist. Reconstructing the person’s face afterward takes true artistry and phenomenal technique.

Take the case of Chevelle Wise. Head and neck surgeon David Huchton met this 33-year-old Baltimore correctional officer five years after she’d had a seriously malignant sarcoma removed. Wise’s entire upper palate, the floor of her nose and her septum had been cut away, leaving a cavernous gap from her mouth to the floor of her brain into which her unsupported nose and upper lip fell. Speaking and swallowing were agonizing.

Huchton’s challenge was to remold Wise’s face to its presurgery configuration. His approach would be one used at only the most advanced medical centers, called the free-flap tissue transfer—taking tissue from one part of the body to reconstruct another. In this case, he would anchor a piece of the fibula—the calf bone—and its attached skin to Wise’s cheekbones, with metal plates to bridge the gap.

Working with his colleague Mark Brown, M.D., Huchton first molded the leg bone and skin into a new upper palate for his patient. Then, using a high-powered microscope and sutures invisible to the naked eye, he attached the blood vessels from the leg tissue to vessels in Wise’s neck, giving life to the transplanted tissue. Huchton took one extra step unique to Hopkins—peeling the skin from the leg bone to expose the fibrous tissue called the fascia underneath and sewing it to the edges of his patient’s mouth and the saliva-producing membrane. Connecting the fascia this way, the surgeon explains, allows the mucous membrane to grow over it in about six weeks.

The entire surgery took seven hours, but today, Chevelle Wise is a remade woman. She has a brand new roof to her mouth and her upper gum and soft palate look and work normally. After the free-flap operation, Wise had two more surgeries to implant titanium studs in her mouth to anchor a dental prosthesis, but she now eats and speaks with no problem.“This surgery,” she raves, “is the best thing that could have happened to me.” For the well-trained head and neck specialist it’s all in a day’s work.

— Gary Logan