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- Nov 30, 2006
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Just had this one on call last night. What would you do?
59 year old man with history of CABG, EF 40%, s/p gastric bypass with 150 lb weight loss now weighing 140 lbs, with newly diagnosed tonsillar pillar cancer. The 6 cm mass is in his right tonsillar fossa and is locally metastatic to his right cervical lymph node and parapharyngeal area, which has resulted in complete inability to open his mouth. He cannot even get a straw between his teeth. Recent fiberoptic exam (1.5 months ago) by ENT revealed a normal base of tongue and nasopharynx and large eroding mass at the anterior tonsil extending to the soft palate; there is invasion of the right parapharyngeal space and the masticator space. CT of the neck reveals no pathology at the level of the vocal cords or below. There is extensive adenopathy of his right neck.
He was not considered surgically resectable, but is scheduled to start XRT. First he needs to have an infusaport placed, an open gastrostomy tube placed, and his right inguinal hernia repaired. All 3 procedures are scheduled for him to be done in one OR by the same surgeon.
The patient is extremely cooperative.
59 year old man with history of CABG, EF 40%, s/p gastric bypass with 150 lb weight loss now weighing 140 lbs, with newly diagnosed tonsillar pillar cancer. The 6 cm mass is in his right tonsillar fossa and is locally metastatic to his right cervical lymph node and parapharyngeal area, which has resulted in complete inability to open his mouth. He cannot even get a straw between his teeth. Recent fiberoptic exam (1.5 months ago) by ENT revealed a normal base of tongue and nasopharynx and large eroding mass at the anterior tonsil extending to the soft palate; there is invasion of the right parapharyngeal space and the masticator space. CT of the neck reveals no pathology at the level of the vocal cords or below. There is extensive adenopathy of his right neck.
He was not considered surgically resectable, but is scheduled to start XRT. First he needs to have an infusaport placed, an open gastrostomy tube placed, and his right inguinal hernia repaired. All 3 procedures are scheduled for him to be done in one OR by the same surgeon.
The patient is extremely cooperative.