Maxillofacial surgery is surgery of the mouth, face, jaws and neck. So we are doubly qualified – we need degrees in medicine and dentistry. My father was a doctor and encouraged me to do dentistry, but I was inspired by one of my professors and returned to medical school. Now I work at the Royal Marsden hospital, London, and specialise in cancer.
Monday morning is flexible so I do paperwork and see any patients who are still in hospital. I also do urgent operations – including short 15 to 20-minute procedures such as examinations to assess the size and extent of cancers.
In the afternoon I am in the Rapid Diagnostic and Assessment Centre (RDAC), a new unit where patients who have an urgent diagnosis of suspected cancer can be referred by doctors and dentists. We make images and do biopsies on the day of initial consultation so we can tell patients if they do or don't have cancer as quickly as possible. Monday evening is spent seeing pre-operative patients.
On a Tuesday I will be in at 7am and will spend between eight and 10 hours operating on a single patient to remove their cancer and reconstruct the defect. I recently operated on a chap with cancer in his lower jaw, carrying out a free tissue transfer. The patient had the fibula bone from his lower leg transferred up into his face. Blood vessels from the leg were then joined up with arteries and veins in the neck to keep the bone alive. The blood vessels are just a few millimetres in diameter so are joined under a microscope.
The demanding aspects of these operations are making sure the cancer is completely removed and reconstructing the patient. With head and neck cancer you have to restore people so that they can return to society. If you have a mastectomy, that can be relatively easily concealed under clothes, but if you have your jaw removed that is more noticeable and can be difficult socially as well as physically.
Cancer is a long battle for patients: they're in hospital sometimes for a few weeks after surgery, then often have radiotherapy. It's all an insult to the body. What's nice is when you see people months down the line, free of disease, returning to their job and interacting with other people normally.
On Wednesday mornings from 8-9am we have a teaching session for our junior staff. Then we have a multidisciplinary team meeting with about 25 or 30 people to discuss the new cancer patients who have come to the unit. The meeting includes surgeons, oncologists, radiologists, pathologists and support services such as speech and language therapy. The rest of the day is spent seeing outpatients.
Thursdays I go to Charing Cross hospital for another meeting and the afternoon is spent catching up or seeing patients. On Fridays I work privately, mainly seeing cancer patients, but also cosmetic work. Some Saturdays I will be back at the Marsden for cases similar to Tuesday's: the operations I do take hours, so I can usually only do one patient per operating list.
It can be emotionally challenging breaking bad news to the patients, supporting patients and their family, and getting them through their hospital stay. But it's fantastic seeing them eight months on when they have gone back to their old life. In the last decade there has been a sea-change away from focusing just on survival towards the importance of quality of life. Fortunately the majority of patients are cured, reconstructed well, and feel able to go back to their pre-diagnosis lives.
