Any Ideas?

On tidying out my sock drawer the other day, I found this souvenir.

NO, it’s not my age! Any guesses what it is?

Where did you get that hat?

In March 2007, I underwent an extremely rare operation in a specialist surgical unit in Nottingham. A Riedel’s procedure is an operation of last resort and is only used in patients where all other surgical treatments have failed. The procedure causes a cosmetic defect in the forehead but reconstruction can be done at a later stage if necessary.

This first picture was taken to mark my safe return from the operating theatre. During the surgery my head was opened from ear to ear via a zig-zag coronal incision and my ‘face’ was peeled back to the bridge of my nose, to expose the front of my skull. The diseased anterior wall and floor of both frontal sinuses was cut away leaving behind a large hollow in my forehead. The edges of this bony hollow were then ‘chamfered’ (planed) to make a gentle curve so that the soft tissue of my face could fall in and line the hollow area.

My ‘face’ was then put back where it belongs and the coronal incision was stapled together before a pressure bandage was applied with a drain in place to minimise haematoma formation. Ten days later, the staples (all 59 of them) were removed from my scalp and I was well on the way to making a good recovery. I’ll never forget how good it felt to be able to wash my hair again.

The pictures below document my recovery following this operation. My return home from hospital in April of that year happily coincided with the early arrival of summer so I got to enjoy a whole month of lazing around in the sunshine. The sun proved to be a perfect tonic and quickly dried up the pressure sores on my forehead.

In the last year, I’ve had two further operations on my head in Nottingham plus extensive IV antibiotic therapy to eradicate a bone infection. The final photograph shows how my face looks today now that all the swelling has finally subsided. Reconstructive surgery is available to improve the contours of my forehead but having recently discussed the options with my surgeon, I’ve decided not to proceed.

I’m more than happy to leave well alone.

Making History

Last June, I was admitted to a specialist unit of an NHS hospital for surgery on my head. I was no stranger to the place having had a major operation there two years previously. Revision surgery was now required as further complications had developed. On this occasion, I was under the care of  a surgeon who specializes in image-guided endoscopic surgery. I was about to undergo an operation which required high precision and carried a significant risk of accidental damage to critical organs. I was also about to make medical history.

I was admitted to the hospital the day before the operation, to be assessed for the complex surgery which lay ahead. My first port of call was to a photographic studio in the basement of the hospital, to have my head photographed from every angle. This was because of my stunning good looks to record the cosmetic defect in my facial profile, due to previous surgery. Next, it was off to the nuclear medicine department to have my head scanned under the supervision of the surgeon. These scans were subsequently used for navigational purposes throughout the technically demanding surgery.

When all the preparations were complete, it was time for a consultation with the surgeon and his team. It was at this stage I learnt that plans were afoot to record my operation for teaching purposes. My history of multiple sinus surgeries* provided the surgical team with an unusual challenge and the operation now planned, had the potential to become a valuable training resource. I had absolutely no hesitation in granting them permission to make me a ‘film star’ for a day. Anything that helps to lessen the risks associated with complex surgery and ultimately, increases patient safety, is to be encouraged.

*For those with an interest in Otorhinolaryngology…

My ENT surgical history includes : A bilateral antrostomy; a Caldwell Luc procedure; multiple endoscopic nasal surgeries; 5 external frontoethmoidectomies; a Riedel’s procedure and a modified endoscopic Lothrop procedure (Draf 111).

My ENT medical history includes recurrent sinus infections, chronic frontal sinus disease, MRSA infection, orbital cellulitis and osteomyelitis.

I also have an inherited connective tissue disorder called Ehlers-Danlos syndrome (EDS) which has added to the complications over the years.

Well, as you can see, I’ve lived to tell the tale. While the signs are encouraging, it’s still too early to know if the latest operation will prove successful in the long run. After what seems like a lifetime of surgery, I feel I’ve earned a place in medical history.

Any guesses what label I’ll be given? 🙄

That’s Life!

I heard an item on the radio this morning concerning an article written by the journalist Kevin Myers, in today’s Irish Independent. In this piece he refers to the perfect contours of the late Princess Diana’s nose which, when combined with her appealing eyes, made her into a real photogenic beauty. It started me thinking about the contours of my own nose and forehead which have been altered by recent surgery. My medical history is complex – I’ve had a lot of surgery, in various specialities and have the surgical scars to show for it – but none of these compare to living with a slight facial disfigurement.

I was admitted to an NHS hospital in northern England earlier this year to undergo a complex operation at a specialist Head & Neck surgical unit. This surgery is unavailable in Ireland unfortunately. I have a long history of serious sinus infection which has necessitated regular surgical intervention and intensive antibiotic treatment over the years. As a result of this, I now also (surprise, surprise) have a history of recurrent MRSA infection. The MRSA presented itself as orbital cellulitis following my last episode of frontal sinus surgery and this infection manifested into chronic osteomyelitis in the frontal bone of my skull. All surgical efforts to establish drainage from the frontal sinus had failed and despite intensive antibiotic treatment, I continued to develop abscesses in the bone close to the base of my brain. As this had an associated risk of developing into a brain abscess/septic meningitis, I was referred to the UK for assessment. Here I was advised that the most effective way to stamp out chronic osteomyelitis would be to have all the infected/dead bone removed, and an operation called the ‘Riedel procedure’ was recommended. I was fully informed that there would be a cosmetic disfigurement post-operatively and having considered my predicament very carefully, I finally agreed to proceed.

My little friend, the superbug, is thankfully still responsive to a tetracycline antibiotic, Vibramycin (Doxycycline), and this enabled me to obtain the requisite ‘all-clear’ from MRSA screening prior to the surgery. The operation itself went very well and was completed in just under four hours. My head was opened from ear to ear (zig-zag coronal incision), my ‘face’ was peeled back to the bridge of my nose and the anterior and inferior walls (bone) of both frontal sinuses were removed completely leaving a large hollow in my forehead. The margins of the frontal sinus along with the supraorbital rims were then ‘chamfered’ (planed) to make a gentle curve rather than a sharp step out of this hollow. This allows the soft tissue of the face to fall in and line the vacated frontal sinus area and improves the cosmetic defect which results from the procedure. My ‘face’ was then put back where it belongs and the coronal incision was stapled together before a pressure bandage was applied with a drain in situ to minimise haematoma formation. I had no post-operative complications other than vomiting copious amounts of blood when in the recovery room – this had drained into my stomach during the surgery. Ten days later when I had the staples (59 of them) removed from my scalp, the incision was healing beautifully and I was well on the way to making a good recovery.

That all happened five months ago and I remain free of infection. The post-operative numbness of my scalp has almost resolved though it has left behind an unpleasant neuralgia which requires medication. The surgery has left a definite legacy – a facial cosmetic defect. The bridge of my nose ends abruptly where the large hollow begins in my forehead. I’ve got used to seeing my new ‘look’ in the mirror although photographs still tend to take me aback. I’ve also had to get used to having conversations with people, usually strangers whose eyes are firmly fixed on my forehead while they try to work out what’s happened to the contours of my face. I’ve had a few tactless comments but nothing that humour can’t handle. You have to keep things in perspective – I’ve been given a second chance at life – not everyone gets that chance. My surgeon has offered re-constructive surgery (a split calvarial bone graft/titanium plate) in the future but for the moment anyhow I’ve no wish to go there and certainly no wish to invite further trouble. And anyway, I’m proud of my war wound – my husband refers to it as the ‘bomb crater’- it was a hard fought battle and I’ve come through it still smiling 😀

I’ve just gotta face it – I’ll never be a Princess Di. But then, that’s life!