Dubai: Two major tumours removed from woman's head and neck in rare, hours-long surgery

Performing a rare surgery, doctors of NMC Healthcare have removed two head and neck tumours – thyroid and parotid – from a 50-year-old Dubai-based Hungarian homemaker.

Krisztina Nagymegyeri is relieved and happy following a long complex surgery spanning hours done by specialists at NMC Royal Hospital in DIP, Dubai.

For the past 13 years, Nagymegyeri has resided in Dubai, assisting her daughter with running her pet shop and her husband with his photography company. However, the past couple of years for her have been challenging.

She has had a thyroid swelling in her neck for more than five years, and another swelling in her left parotid – the area on her cheek below the ear – for the last three. Nagymegyeri's difficulties due to the two tumours included numbness and tingling sensations, along with changes in her voice and difficulties swallowing, as well as occasional facial twitching.

“I visited several clinics in Dubai, and the tumour tissue samples were thankfully non-cancerous. I also have an ovarian cyst, which I wanted to have operated on in another hospital", said Nagymegyeri. "Still, they refused and delayed the surgery due to my thyroid tumour, saying it would be difficult to put in the intubation tubes (breathing tubes); so I should get the thyroid operation first."

Dr Anant Pai, specialist general surgeon and medical director, said Nagymegyeri consulted three different healthcare facilities before being referred to NMC Royal Hospital.

“Krisztina was aware of the diagnosis and had accepted it well. She insisted that both tumours be removed [in] one go as she didn’t want to be subjected to general anaesthesia several times – contrary to the opinion she got from other hospitals who insisted [on doing] one tumour at a time.”

Dr Suhail Maqbool Mir, specialist ENT and head of department, said that removal of parotid and thyroid tumours was three hours of “surgical challenge” because of the complexities involved.

“The right lobe of the thyroid was positioned retrosternal (behind the breastbone) and displacing the trachea (windpipe) – and the large left lobe was compressing it at the same time, which would make the intubation (the process of putting in the anaesthesia/breathing tubes) difficult. Luckily, we [were able to] intubate her at the first attempt and with ease. The surgical difficulty was increased by the exposure of critical nerves and important structures like the parathyroid glands, the carotid artery, the facial nerve and its branches, and the jugular veins.

It was critical to identify these structures, not only to preserve them but to avoid any injury. We also had to deploy a continuous intra-operative neuromonitoring [accordingly].”

Dr Mir noted the successful handling of such a case was unique in the medical practice.

“A detailed review of the literature did not reveal any surgeries done previously on parotid and thyroid tumours simultaneously. Therefore, no comparison or comparative technique to go about the procedure could be obtained. We discussed the case with my peers elsewhere, and all of them suggested that both surgeries could be done, but that it requires caution mainly due to the critical nerves like the recurrent laryngeal and the facial nerve, which are potentially at risk.”

The medical team is happy for Nagymegyeri's speedy recovery, stable state, and pain-free status. Her quick recovery is also because of her non-smoker, non-hypertensive and non-diabetic status.

She was discharged on the next day of surgery. She will require long-term follow-up with an endocrinologist to maintain her thyroid hormone levels in the normal range.

“I am thrilled with the outcome,” said Nagymegyeri on her first follow-up check-up when she came with a sweet Hungarian dish, which she prepared herself, and sweets and cake for doctors and staff members.

Dr Pai added: “Krisztina’s unique case is not a surgery in isolation in Dubai. Quality healthcare in the UAE is on the rise and our country is getting increasingly capable of dealing with complex cases easily in terms of well-trained personnel, equipment and facilities. The aim now is to get international referral cases involving a multidiscipline approach, requiring the necessary expertise, equipment and care to safely conduct such complex surgeries.”

The hospital spokesperson pointed out that the rare surgery to remove both tumours at the same sitting was probably the first.

“Such a case of total thyroidectomy with superficial parotidectomy done in one surgery has not been reported elsewhere. This conclusion is based on an exhaustive review of contemporary literature published for head and neck tumours.”

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