The melancholy boy was 12 years old and stopped speaking completely in July because no one could understand him. Prior to that, he'd been a normal boy doing all the things 12 year old Kenyans do. But, now he was different. His chin was slowly enlarging and he looked funnier every day. As he couldn't talk or be understood, he couldn't tell anyone about the pain that was getting worse every day. His energy was getting consumed by the growing mass and he wasn't able to eat solid food. Soon his own tongue was going to begin restricting his breathing. Unknown to most, the inside of his mouth was slowly filling with a massive tumor that was growing to nearly fill his mouth. Unknown to the boy or his family, the mass under the tongue was not only pushing his tongue up, but it was also pushing the base of his tongue back. Soon, his breathing would become labored. The nearby district hospital in Kisii would encounter a boy in trouble, whom they couldn't intubate. His only chance of surviving would be an emergency tracheostomy - provided someone there was competent to do it on a struggling 12 year old boy who would be fighting for his life.
But that tragedy was not to be! The boy and his father were brought last Thursday by two American missionaries working in Kisii. Somehow, they had gotten word of this Dr Keith, an ENT visiting Tenwek for a short time. A CT scan was performed, the boy was admitted and surgical planning for the next day commenced. The CT showed such a large obstructing tumor that a breathing tube would not pass. An awake tracheostomy was planned for the boy. Additionally, getting the tumor out through the mouth or dropping it down in through the neck was not possible. So, the father consented to a trach and a surgical jaw splitting that would allow the tumor to be taken out the front of the face after dividing the mandible in half and opening it like a book. The case was reviewed with the resident scrubbing the case and homework (studying anatomy, studying the approach and the possible complications) was assigned.
But this level of complexity was not to be! Once in the operating theatre the boy bravely allowed passage of a large bore needle into the bottom of his tongue. Over 100 cc of dark, yellow-brown pus was evacuated leaving room to get a breathing tube in and avoid the trach! Praise God! An incision was made just behind the lower teeth and the tumor dissection began. After several hours of meticulous dissection, the mass came free! Though several large arteries loomed along the periphery of the mass, no substantial bleeding occurred. The jaw did not have to be split, after all! Praise God! The boy was then transported to ICU where he would remain intubated and on a vent for the next 36 hours while the swelling in the tongue from surgery and the mass was allowed to subside.
On Monday the boy was now without his breathing tube, had his drain removed and was eating and talking for the first time in over six months! Praise God! He returned on Tuesday to his life in Kisii to rejoin his friend and family with full power to speak and be heard! My hope is that he will one day praise God with his restored voice and tongue and realize that his life continues only because the love of his heavenly father!