When, in early 2017, Cynthia Zamora bit through her tongue in the middle of the night, she had no idea that a 5.4cm cancerous tumour actually surrounded her tongue.
Zamora at first didn't want to go to the doctor, but when her condition worsened she had no choice but to seek medical help.
It was a difficult situation, but fortunately doctors arrived at a unique solution: They would remove the cancer, then cut out a piece of her left thigh to construct a new tongue for the 57-year-old.
After the procedure she struggled to walk, talk and eat, but soon regained all three functions. And the first thing she wanted to eat? A piece of salty fried chicken from KFC.
A challenging surgery
“By the time I saw her she was really having a hard time speaking and swallowing,” said Dr Califano, director of the Head and Neck Cancer Center at UC San Diego Health. “With Cynthia that was a difficult discussion because it was unclear how much tongue we would save and how good the function would be with the remaining tongue that would be preserved.”
The surgery, which lasted 12 hours, saw Dr Califano removing a large portion of Zamora's tongue before a reconstructive surgeon took over to replace the part of the tongue that was removed.
“The primary goal of surgery is to remove the cancer as best we can while sparing as much normal tissue as possible,” Califano explained. “It was a challenging surgery in that we had to cut just right to save enough tongue so that she would have some function and we could still get well around the tumour. We were able to save less than half her oral tongue. That wasn’t a lot.”
Reconstructing the tongue
Dr Ahmed Suliman, a plastic surgeon who specialises in reconstruction after cancer treatment surgeries was responsible for reconstructing Zamora's tongue.
Dr Suliman performed the life changing surgery using a method known as anterolateral thigh perforator flap (ALT) in which he cut a 6 x 8cm patch of fat and skin from Zamora's left thigh, which was then shaped into a new tongue. After the shaping of the new tongue, Dr Califano was tasked with identifying a vein and artery in her neck with which to connect it before the stitches were put in.
The replacement tongue does not have much movement, but as Dr Califano was able to spare the base of the original tongue, Dr Suliman was able to use it to preserve some movement for Zamora.
However, surgery was only the beginning of a strenuous journey for Zamora. When she woke up form her intensive surgery, she found herself unable to walk, talk or eat.
“When you remove the majority of the tongue, you can’t really function,” Suliman told UC San Diego Health. “You can’t swallow and articulation is limited. We had to rebuild a tongue to provide bulk so that Cynthia could move food in her mouth in order to swallow and to speak.”
Life after the surgery
ALT involves minimal cutting of the thigh muscle in order to extract tissue. This results in a faster healing time as Zamora did not lose leg muscle function. With the help of physical therapy, Zamora found herself able to walk on her own soon after the operation.
Her ability to speak was impaired and would require intensive speech therapy. Zamora and her speech therapist worked hard together in order to target the sounds she had trouble making.
For this to work, Zamora had to slow her speech and exaggerate each sound she made, compensating with her vocal chords for sounds she was now unable to make with her tongue.
“Previously, I was well pronounced with an expansive vocabulary. I had to be patient with myself and use more expressions in my eyes, hands and face. Sometimes I have to pick words I wouldn’t normally use because I can’t use my original vocabulary. Quality is better than quantity,” said Zamora.
In addition to working hard to regain her speech, Zamora had another hurdle to overcome, struggling to eat without a feeding tube. It was only early this year that Zamora overcame this last hurdle.
Speaking on her experience, Zamora is positive and thankful. “With a little patience and care, and one step, baby steps, along the way, you can do anything,” said Zamora. “Look at me. I had no tongue, and now I'm talking. I'm eating. I'm drinking. I'm doing great. There is life after this surgery. Don't give up. Keep going. Be strong. Be stubborn. You can do it, you can.”
