Groundbreaking paediatric tumour removal procedure

Mucoepidermoid carcinoma of the parotid is a malignant tumour which occurs in the salivary glands. Occurring quite commonly in adults, it’s nearly unheard of in the paediatric group.

Ear, nose and throat (ENT) surgeon, Dr Muhammad Essa, reports that he often performs surgery to remove this type of tumour in adults, but on Saturday, 19 November 2016, a three-year-old boy from Pietermaritzburg became the first child in South Africa to undergo this complicated procedure.

The procedure

Dr Muhammad Essa was one of the specialised medical staff who performed the landmark surgery at Mediclinic Pietermaritzburg, together with paediatric surgeon Dr Hansraj ‘Hansie’ Mangray, as well as a pathologist, an oncologist, an otologist and other medical support staff.

‘There were difficulties considering the age of the child as his anatomical structures are very small and that adds a high risk of damaging the nerve which could have resulted in facial disability,’ Dr Essa says, adding that the operation lasted three hours.

A special nerve monitor had to be transported from Durban to Mediclinic Pietermaritzburg for the surgery to ensure there was no nerve damage intra-operatively. He reports that Mediclinic, together with Vision Medical, raised the funds.

‘Initially the mother of the patient was skeptical about this surgery,’ says Dr Essa. ‘And throughout the surgery we had to think about the child’s parents sitting in the waiting room hoping and praying that the surgery would be a success’. He says that the medical team, as is often the norm, said their prayers prior to the procedure.

‘We had to put ourselves in the family’s shoes and think about the young boy’s future. There was no room for error because that would have resulted in half the patient’s face being paralysed,’ says Dr Essa.

The surgery was successful and the tumour was removed without complications. The patient stayed in critical care overnight and was transferred to the paediatric ward by Monday morning, by which time he was eating well and already active.

Noting the mother’s initial hesitation to surgery, he adds: ‘Had we not performed it, come six or 12 months down the line we would not have been able to assist the child.’

Mucoepidermoid tumours of the parotid

Most tumours that occur in the salivary glands are benign and occur in the parotid glands. The tumour occurs as a painless salivary mass and is evaluated by fine-needle aspiration biopsy.

Malignant tumours of the salivary glands, which are firm and nodular, are less common; often fixed to adjacent tissue. Mucoepidermoid carcinoma, which typically occurs in people aged 20 to 50, is the most common salivary gland cancer. The tumour is able to manifest in any of the salivary glands but typically presents in the parotid gland.

There are three grades of the mucoepidermoid carcinoma of the parotid, with intermediate and high-grade tumours at high risk of metastasis to the regional lymphatics.

The young boy from Pietermaritzburg, fortunately, presented with a low-grade tumour and a good prognosis, provided the entire tumour was removed with good clearance margins.