Innovative Cheek Reconstruction Uses Tissue from Patient’s Arm

Kathy Estabrooke clearly remembers it started as a small, white line on her inner cheek. She and her dentist had been keeping an eye on it for well over a year when it suddenly changed in appearance and became painful.

Never one to procrastinate, Estabrooke had her NorthShore Dermatologist Reshma Haugen, MD, take a look. Dr. Haugen expressed concern that the growth might be a dangerous form of skin cancer and directed her patient to have it biopsied immediately. The result was understandably scary: oral cavity cancer.

DECISIVE MOVE

“I was devastated but wasted no time to call a dear friend of mine who’s an oncology nurse at Kellogg Cancer Center,” recalled Estabrooke. Following her friend’s advice, the 65-year-old Northfi eld resident made an appointment with Head and Neck Cancer Surgeon Mihir Bhayani, MD.

“The minute Dr. Bhayani walked into the exam room, my husband and I knew we made the right decision,” said Estabrooke. “He was calm, reassuring and hopeful.”

“Kathy’s tumor was small, but it was located in a diffi cult space,” explained Dr. Bhayani. “The deeper surface of the tumor rested on cheek skin and included critical nerves and muscles that control facial motion and expression. We needed to treat her cancer while preserving the function of her cheek.”

TRANSFORMATION VIA TISSUE TRANSFER

In collaboration with Kathy Estabrooke’s dermatologist, surgeons Dr. Cheryl Nocon and Dr. Mihir Bhayani teamed up to remove her mouth tumor and then reconstruct her inner cheek using tissue from her forearm.

Working alongside Reconstructive Surgeon Cheryl Nocon, MD, Dr. Bhayani fi rst removed Estabrooke’s cancerous tumor, as well as surrounding lymph nodes and salivary gland tissue. Then Dr. Nocon took on the intricate task of reconstructing Estabrooke’s inner cheek.

“We performed a procedure called microvascular free-tissue transfer, which involved removing tissue from Kathy’s left forearm and using it to reconstruct her cheek lining,” said Dr. Nocon. “This was the best option for preserving Kathy’s ability to open her mouth normally.”

According to Dr. Bhayani, one of the great things about NorthShore is the multidisciplinary teamwork between the Division of Otolaryngology and the comprehensive Head and Neck Cancer team at Kellogg Cancer Center, including surgical, medical and radiation oncologists, therapists and dentists.

“By working together and performing both procedures at once, we can decrease the time a patient is sedated and in the operating room,” agreed Dr. Nocon. Both surgeons hold academic appointments at the University of Chicago Pritzker School of Medicine.

“My NorthShore team was just amazing,” beamed Estabrooke, who admitted her goal after surgery was to be able to open her mouth wide enough to eat a Big Mac. After several months of physical therapy and rehabilitation—and a strong support system of family and friends—she reached her goal, even sending a picture to her care team through a message on NorthShoreConnect.

“One of the coolest images I have received is that picture,” added Dr. Bhayani. “Kathy was amazingly attentive to rehab after surgery, which was crucial to her successful recovery.”