– This case is unique in the sense that even though we see a lot parotid tumors in different patients, females and males, and young patients, older patients, this particular patient, she’s pregnant and she was diagnosed with a parotid tumor when she had just found
out that she was pregnant. So that makes it very different from any other parotid tumor case. – It’s kind of a rare situation. Of course, if it’s something that can wait until the baby is born,
Dr. Osborne would do that. However, with this case, we don’t know if it’s a cancerous tumor in her gland and it was progressing fairly quickly so we didn’t want to wait too long or wait til the baby was
born to remove the tumor in case it was cancer. – [Dr. Osborne] My name is Ryan Osborne. I trained as a head and neck surgeon in South Central Los Angeles managing the most complex
cancer and trauma patients in the country. I’ve operated across the globe in first and third world countries. My experiences has taught me a value of flexible and innovative thinking but I realized that our health care system doesn’t always allow for that. So I started Osborne
Head & Neck Institute. I made it my mission to find the best, the most creative surgeons around and I gave them the space to excel. Together we created a
new standard in medicine. These are our stories. (boat horn honking) (light upbeat music) – [Narrator] San Francisco
has come a long way since it was founded centuries
ago as a Spanish colony. It’s now a bustling and vibrant city. Home to iconic landmarks such
as the Golden Gate Bridge, Ghirardelli Square, and Fishermans Wharf. A mecca of food and culture, San Francisco has a Victorian elegance alongside the vibrant
technology of Silicon Valley. I spent a lot of time
within these city limits as a student at Berkeley. I remember learning to drive
stick shift on the hilly roads and finding cool cafes to part myself for a day and study. This is the city you fight to get to. Diverse, expensive, cultured, San Francisco is not a stop along the way, it is the destination. San Francisco is home to many
prestigious medical centers. The savvy residents of San Francisco do not settle for second best. This is a town where
decisions are researched, vetted, and then checked three more times. It’s in this setting that we
meet our patient, Rhiarose. – At the end of last year 2015, I had noticed a lump underneath my earlobe and I thought it was
maybe just my lymph node and that maybe I was sick and that’s why my lymph node is just enlarged. I went to see my primary
care doctor and she noted it. She had recommended
that I see an ENT doctor just to get it evaluated. During my first appointment
with the ENT doctor, he told me to just go ahead
and get a fine needle biopsy because that’s the only way
what they’re gonna find out exactly what it is. – Unfortunately, the pathologist came back with two diagnoses that were possibilities and those were benign, but two others, unfortunately,
that were malignant. – So to make things a lot more difficult, one week after we found out the biopsy from the needle biopsy report, I found out that I was pregnant. – A pregnancy that early
in the gestational period, the baby’s still developing. – It was a little mixed emotions because it was supposed to be a time when, a time when we would be happy that we were expecting and adding another member to our family. But of course, there was
a big concern in my heart. – The mother at the same time is worried about having a cancer and so the complex nature of this is that in the patient’s mind, they’re worried about their baby developing healthily and trying to take care of themselves so they can be there for their child. – And if this happens to be a malignancy, time can be of the essence
and getting it out. – You know your best chances
of treating any tumor that potentially can be cancerous is to take it out as soon as possible. – Or she could play the other odds that this is benign and wait. – So the first time that
I talked to Rhiarose was probably six months
ago when she emailed about her diagnosis of a parotid tumor and also stating the fact that
she was 10 weeks pregnant. – Anytime you’re operating
on a patient’s parotid gland, you’re always concerned
about their facial nerve. But at least in those situations, there really isn’t a second life that you’re kind of thinking about. But now with a pregnant patient, you got two lives, you’ve got two people that you’re concerned about on the table, and that absolutely complicates things. – We had to make sure
that we got the clearance from her OBGYN doctor back home and then we also connected
her with an OBGYN office here at Cedars-Sinai Hospital to follow her and to monitor while she’s
here and during the surgery. We wanted an OBGYN to be available and ready to come into the surgery if needed, if anything happened. – The baby’s gonna need to be
monitored during the surgery to make sure there’s not any fetal stress during the procedure. From a surgical standpoint, we want to be as meticulous as possible. Some of the risks are facial paralysis which means that the patient’s face would not be able to move on one side. – And unfortunately, there
are two types of paralysis. There’s permanent paralysis,
which that never recovers and that generally comes from somebody accidentally
cutting her nerve. And then there’s temporary paralysis. Temporary paralysis comes from nerves being manipulated a lot or moved a lot and what happens is you
get secondary swelling and inflammation and edema. The nerves don’t conduct
electricity very well and it also looks as if
you can’t move your face. However, as it is called temporary, as that swelling goes
down, as an edema resolves, the nerves will conduct electricity again and the face will look perfectly normal. – The other risk of the surgery are having some kind of facial deformity, depending on how extensive
or how far the tumor spreads to different parts of the face. – And when we start to talk
about Rhiarose’s situation, the risk is a little bit higher. She’s pregnant so we have
to consider time now. We don’t want her under
anesthesia for too long. The longer she’s under anesthesia, the longer the baby, in
our opinion, is at risk. – The more you know sometimes, it’s actually a little bit scarier. I started reading more
on the actual incision and how the possible
complications of nerve damage. – When I look at Rhiarose, I realize she’s got an
Asian ethnic background. I usually know from experience that means the caliber and the size of her nerves will be much smaller. I also know her tissue will be more dense and harder to dissect through. So I’m already trying to think, how am I gonna approach this
person using these instruments and causing the least amount of trauma. – I have kids, you know,
and I’ve been pregnant and during your pregnancy,
you’re scared regardless because you just don’t know
what’s going on with the baby. But putting yourself in
a situation like this, I can only imagine. It would give me a lot of anxiety. – I think she’s gonna be great. She’s got a very positive
attitude going into it. She didn’t seem very scared or nervous or anxious in any way about it. And I do believe patients
going into something like this with that mindset, the
outcome is much, much better. And she’s in the best hands possible with Dr. Osborne and Dr. Hamilton so I’m confident she’ll be alright. (lightly chattering) – We discussed that within the
three hour window of surgery that they were gonna take a slice of it and then send it off and then results would come back. How you feeling? – [Rhiarose] I was really
glad to finally see my husband when they finally let him in and I was just anxious to finally get into the operating room. – It moved along much like I
thought it would move along. The nerve was extremely
small and very delicate and very elegant and very complex. And the surrounding tissue was very dense, very tough, tenacious tissue and we had to fight through it. It’s like kind of trying to move through the Amazon jungle
cutting down 12 foot brush while trying to hold on to
those delicate figurines you cannot drop. It’s really using two
different parts of the vile. You need to use force in one hand and you need to be very
delicate and precise on the other hand. And that’s the challenge I
thought we would encounter and that’s exactly what we did encounter. When she woke up from anesthesia, usually people are very groggy and they don’t know where they are, they’re slurring their words,
they’re very disoriented. She woke up and she immediately said, “What was my pathology? “What were the margins? “How did it go?” I mean she’s talking as if
she’s been awake for two weeks and I found that to be very unusual but, again, we’re all different in life and she’s just another example of that. – I was really excited to see my husband and Rhylan after surgery. And just to be able to
go home and just relax and not be in the hospital. – If I were in the same
situation as Rhiarose and I had this surgery, and I went through the type of dissection and trauma that her nerve went through, my face would not move at all. I’d be completely paralyzed,
probably for six months. – I still feel like my, there’s numbness in my tongue. – The fact that she’s moving
that much, it’s incredible. But it’s just a testament
to the differences and how we all respond to trauma. – Great, come on back.
(laughing) – Good morning! (laughing) – The drain is just a little tube that comes out from behind the ear and it collects fluid that
may build up after surgery. That usually gets removed
the day after surgery. Deep breathe out, just keep
breathing lightly there. Breathe out. Drain is out. We’re gonna put a little
antibiotic ointment here. Until the sutures come off, just put on a little
ointment on twice a day. We should have the pathology back beginning of next week, if not today. – Okay. – I’ll call you with them. – Okay. – That’s it and I thank you. – Thank you. – It’s still not determined whether it’s benign or malignant. It’s still kind of weighing on my mind. – Once we remove the actual tumor and take it out of her body, we cut it in half and we send half of that to the pathologist who do
an intraoperative analysis of the specimen. As Murphy’s Law would have it, they still did not have an answer. – So going into the surgery and going through this whole process, of course, our hope was
always that the results would just come back as benign. – [Dr. Osborne] Usually
we get a pathology result after surgery within one to two days. That’s when the case is straightforward and there’s no real question
as to what the diagnosis is. Every once in a while,
there’s a lot of question as to what the diagnosis is and it also involves usually
more than one pathologist to make that diagnosis. Unfortunately this is
one of those situations. – When I realized it had already
been 10 days from surgery, and I hadn’t heard anything,
then I started getting worried. I found out the results yesterday. – It can’t be good news
if it’s taking this long. – So I’ve been really anxious, we’ve been waiting since
Friday of last week and we thought we could
hear from them on Monday and then we didn’t hear all week. We kind of just been resting
and totally forgot about it. But the other day, since
it’s been like 10 days, started getting worried,
how come we haven’t heard. Come here Rhylan. I’m on the other side. So Dr. Osborne just text
for me to call him back so we’re gonna call him for the results. When Dr. Osborne told me the report. – What we got back was, – We did question in Rhiarose’s
case, there’s always been “Is this a benign tumor
or is this cancer?” And even with several
pathologists working together, it took them quite some time to finally come up with a diagnosis of a benign parotid tumor. Had we actually gotten malignant cells, she would’ve needed to
have her incision extended, there would’ve probably been
another two or three hours of surgery as we would’ve had to assess the lymph nodes in the neck and try to see if there’s been any spread
of that cancer anywhere else. (sighing) – The feelings that were going through my mind was relieved that I didn’t have to worry about not being here for my family. I think that was, that’s the real number one thing that was devastating for me. I wanna be here for a very long time. I wanna be here for my kids. I wanna be here for my husband. And the fact that the results coming up as benign, I just felt so, I was so happy, so glad that that’s what it was and I don’t have to think about that and that’s not what can be my reality in the next five to 10 years. So now that we finally got the results and we’re healing from the surgery, I need to focus on this baby. I’m 24 weeks and he probably hasn’t gotten all the attention that he’s had because I had to focus on myself and making sure that I was
okay and that I would be okay even during the rest of
the pregnancy and after. And so now that this is all said and done, and we know that everything is fine, I don’t have to do any radiation. I could just start decorating the nursery, buying things for the
baby, doing happy things, and just being excited for the
new addition to our family. – I’m not gonna tell someone
that there is no risk. There is risk. And whenever you manipulate
someone’s nerve that much, there’s a high chance they’re gonna have some temporary paralysis
and you gotta get them to understand the success in this surgery may not be what they think it is. But you have to bring
them back to reality. You have made it through a surgery, you and your baby safely. The tumor is completely removed. Your facial nerve was not cut. Your pathology was benign. And you may have a little
bit of temporary weakness just from edema but that
will resolve in a few months. So at the end of the day, this is a 100% success story. I mean, I’m extremely
happy with the results. But it’s again, keeping
people in perspective, being very straightforward and honest and understanding we’re just here to help. I’m just a man, I’m not God, you know, but we’re trying to do God’s work here. (somber music)

20 Replies to “PREGNANT with PAROTID TUMOR”

  1. sir if u r reading this msg thn i need ur help
    sir i m suffering with neurofubrometosis
    i dont knw is it nf1or nf2 but i need ur help

  2. hi sir my name is shaista from india i have premorphic adenoma in last 7 years .igot 2 surgery but its comming a 3rd time .i am very disoppont to my life because i really very tens about this desease .plz help me i am not afford your fee .plz come to india for very needed people .plz give reply

  3. Decisions are researched, vetted, and then checked 3 more times??? Are you kidding me DOC? Have you seen the local news on San Fran? Love your cases, your professionalism, and understand you have to be PC about SF but that place sucks rocks.

  4. I too was pregnant when I had this surgery. This was my second time with the same problem. At age 14 it was removed and was malignant then 15 years later , 7 months pregnant with my first child I found the tumor again but much smaller. We waited until I had the baby for surgery. It was followed by radiation. My baby is now 37 years old.

  5. …and yet PC culture insists that Races are all Exactly the same… and gets violent if you say that there are biological differences between the races.

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