Hieu

Ten-year-old Hieu was so much like any boy his age. He waited patiently for his turn during the screening. He was weighed by the nurse. We took his pre-operative photos and vital signs. He was observant, watching each of our team members and trying to make sense of what was happening in the room.

Then he could not contain himself any longer. He came and stood close to me with his back to me. He turned his head over his right shoulder, smiling widely. I did not quite know what he wanted and could not communicate in Vietnamese. So, as with any boys his age, I playfully took his shoulders in my hands and shook him side-to-side from head to toe. He burst out laughing, as if he needed some comic relief.

Next, it was his turn to be screened. The surgeons, anesthesia crew, and nurses encircled this little guy and all somberly considered his tennis ball-sized tumor that had been growing unchecked for two years. It now involved his upper teeth on the right side of his face and was positioned underneath his right orbit (eye socket.) In profile, it protruded forward past the tip of his nose. His right lower eyelid was pulled down by the weight and stretch of the tumor itself.

Hieu's mother's facial expressions were of much concern by someone who has watched her beloved son's tumor enlarge daily in recent years. Occasionally she would have to collect herself emotionally as her son was scrutinized. She and Hieu were accompanied by his father and an extended family of aunts and uncles. They came from the very southern tip of Vietnam near Can Tho. They had made the journey to Ho Chi Minh City before only to be turned away. But this time they returned yet again, still holding on to hope.

Hieu was selected as the first case on the schedule on April 14, 2010 at the National Hospital of Odontostomatology (NHOS) in Ho Chi Minh City. We met with his aunt just outside the operating room. She was tearful, but not nearly as much as Hieu's mother who could not bear to be with him so near to where he would have his surgery. We prayed with them and walked Hieu into the OR where he climbed up on the table himself. His eyes were big and he was quiet. When BC Shauver, FTC nurse anesthetist, placed his anesthesia mask on his mouth Hieu cried loudly in fear. But the anesthestic gas quickly took its effect and he relaxed and slept.

Dr. Randy Robinson was assisted by Dr. Bui Huu Lam and other Vietnamese surgeons. It took about seven hours to remove the large cheek tumor, harvest an anterior hip bone graft, place it in the void the tumor left, and close the incision lines from Hieu's lip, along the right side of his nose, and underneath his right lower eyelid. It was necessary for Dr. Robinson to do a coronal incision, which included temporarily peeling back his scalp in order to have better access to the tumor. So, once the tumor was removed and the hip graft was secured with titanium bone plates and screws, the facial incision was closed with suture and the scalp incision was closed with staples (in place for about ten days.)

Hieu woke up as 10-year old boys often typically do - loudly and vigorously - and was wheeled to the recovery room. Concerned about the status of Hieu's vision after the surgery, Dr. Robinson asked Hieu to look into the mirror provided and describe what he saw. Hieu answered with what was obvious to him, "A mirror." The staff laughed, relieved to know Hieu could see without difficulty. In fact, he saw himself with a head wrap on and the fullness of the tumor was now gone.

Hieu recovered well after his surgery. His family was so relieved, expressing profuse gratitude. They returned two months after Hieu's surgery for his post-operative follow up. He experienced no complications and the swelling is now gone. He will need a partial denture for the right upper side of his mouth. But, otherwise Hieu is healthy. Our whole team is so pleased with the outcome of Hieu's difficult surgery. We pray he has no recurrence of the tumor and his future is bright.