Soothing Team Makes Cancer Patient Feel ‘Like a Hotel Guest’

Cancer discovered during a routine dental cleaning leads to complex head and neck resection, reconstruction

A diligent dental hygienist first noticed the tiny white spot on the underside of Joe Bidinger’s tongue during a routine teeth cleaning. That tiny lesion was a harbinger of a healthcare odyssey to come, where the Madison Township man would endure an involved nine-hour surgery to remove the cancer and surrounding 76 lymph nodes and reconstruct his mouth and lower jaw.

All the while, he was awed by the support of his comprehensive healthcare team.

Rod Rezaee, MD, Director of Head and Neck Surgical Oncology and Reconstruction at the UH Ear, Nose and Throat Institute, made sure Joe knew that he would be with him every step of the process. And he introduced Joe to his entire surgical team.

“When you go into a hospital, there’s a fair amount of stress,” said Joe, who went to UH Cleveland Medical Center for his squamous cell cancer surgery. “There’s a given level of anxiety. Dr. Rezaee just makes that go away. His body language, it talks to you – verbal and nonverbal. It was prevalent in the whole team.”

Dr. Rezaee’s face was the first one he saw when he awakened after surgery. And every morning and evening, members of the surgical team stopped in to see Joe in his room.

“When I went into UH, I felt like a hotel guest and not a hospital patient,” Joe said. “You could tell they really cared. They were all intelligent and dedicated. You could tell Dr. Rezaee believes in a coherent team, and the care is teamwork all the way from the beginning to the end.

“My previous experiences in other hospitals were nothing compared to this.”

Dr. Rezaee credits the oral cancer screenings now done in dental offices with finding the initial cancer. The hygienist noticed not only the white spot on the bottom of the tongue, but a questionable look of the gum lining.

“Sometimes these signs are fairly subtle,” Dr. Rezaee said. “Thankfully the screening tests we have through the dental programs are working.”

Two teams of surgeons worked to remove the cancer and perform reconstruction in the same operative setting. For Joe’s surgery, the experienced team consisted of Pierre Lavertu, MD, to remove the squamous cancer cells, and Dr. Rezaee to reconstruct the area after the cancer was resected.

Squamous cell carcinoma, one of the more common forms of head and neck cancers, is generally very treatable and curable when found in an early stage. But to ensure he reached all the tentacles of this invasive cancer, Dr. Rezaee had to take out a ring of tissue around the suspicious lesion as collateral damage. To perform reconstruction, he used tissue from the underside of the arm that mimics the tissue in the mouth. Joe’s surgery affected the undersurface of the tongue, the gum lining between and around the teeth, the floor of the mouth and the upper third of the lower jaw.

“It can be functionally devastating for patients, but thanks to microvascular reconstructive procedures using tissue transfers, teams can restore form and function for patients like Joe so they can learn to eat, speak and swallow again,” Dr. Rezaee said.

In a transoral surgery, the surgeon works through the mouth and carefully cuts across the neck to remove nearby lymph nodes, to take care of any cancer cells that may have spread undetected. The surgeon carefully hides incisions in natural skin folds.

The body, in many cases, has predictable pathways for where cancer will spread to lymph nodes, Dr. Rezaee noted. Given the location of the cancer in Joe’s mouth, it could easily have spread to either the right or left side of his body. Of the seven regions of lymph nodes, the team removed four on each side of Joe’s body in a thorough sweep, for a total of 76. Thankfully, only one showed cancer.

During a six-day hospital stay, Joe felt he was treated like a hotel guest. His care team had him up and walking early, which shaved time off what, in some cases, could have been a two-week stay if complications arose. His nurses explained how to manage the feeding tube and wrote out precise, detailed instructions for his return home.

Recovery is a complex process, says Dr. Rezaee, and the patient needs the support and care of the entire team. The surgeon ensures that his surgical team is aware of the complex nature of the post-operative process, including drains, tracheostomies and feeding tubes, as they learn to eat and talk again.

“Joe recognized the team-based care, which is what we strive for at UH Seidman Cancer Center,” said Dr. Rezaee. “It takes a cohesive, well-trained and dedicated team to deliver this high level of care. Fortunately, at UH we have a great team in the clinics, operating room and hospital dedicated to head and neck cancer patients. It is a true joy to come to work when you have people like these working to motivate patients like Joe.”