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Form and Function:

Curing Head and Neck Cancer is Only Part of the Challenge, con't.

"There was an element of confidence -- a 'We can do this' attitude," she says of her treatment team. "That made me feel better." Because tongue cancers don't respond well to chemotherapy and radiation, Bourdon-Krause's team recommended surgery: removing half her tongue and all the lymph nodes in her neck on the side where the cancer was found. The tongue, basically a single slab of muscle, has no barriers to prevent cancer from spreading from the spot where it starts, "so you want to make sure you get an adequate margin around the tumor to ensure that it doesn't ever come back," says Bradford, who performed Bourdon-Krause's surgery.

At one time, removing half of her tongue would have meant that Bourdon-Krause wouldn't be able to consume a normal diet, particularly in public, and her speech would be forever slurred, with a "sloppy, two-or-threebeers-onboard" quality, says Douglas Chepeha, M.D., who reconstructed Bourdon-Krause's tongue after Bradford removed the tumor and surrounding tissue. But thanks to Chepeha's skills -- and his willingness to go to great lengths to make sure the tongues, jaws and cheeks he rebuilds function as much like the originals as possible -- Bourdon-Krause could lose half her tongue and still look forward to teaching her son the alphabet and taking him out for burgers.

Reconstructing Function by Micro Repair

On the table before him, Chepeha spreads out a small square of paper on which he has drawn a pattern of numbered, interlocking pieces, something like the design for a child's first jigsaw puzzle. It's the pattern for Bourdon-Krause's tongue graft. Through his own research and consultation with speech pathologists, Chepeha has come up with benchmarks that reconstructed tongues must meet, so that patients can function in public with respect to eating and speaking. For example, a tongue needs to touch the back of the teeth to make certain consonant sounds, and it should be able to stick out 5 millimeters to 7 millimeters beyond the teeth in order to lick crumbs from the lips.

To reconstruct Bourdon-Krause's tongue during the 11-hour surgery, Chepeha designed a patch of skin and underlying fat from her forearm for transplantation. He folded it like origami and painstakingly connected tiny blood vessels in the transplant to vessels in what was left of Bourdon-Krause's own tongue.

The night before her surgery, fearful that the reconstruction might not be successful and she'd never be able to speak to her 2-year-old son, Logan, Bourdon-Krause had stayed up late recording messages for the child.

"I started thinking, if I couldn't talk ever again, what would I want to say to him?" she recalls. "Some of it was basic mom-of-a-toddler things like, 'come here, let me change your diaper.' But part of it was a lasting keepsake I wanted to create: 'how was your day?' 'i love you.' " After several tearful tries, she also recorded herself reading some of her son's favorite storybooks.

It was a loving gesture, but one that, happily, turned out to be unnecessary. Within a week after surgery, Bourdon-Krause was talking, and with continued speech therapy her enunciation improved. She was back at her job as a graphic designer, participating in meetings and making phone calls to print vendors six weeks after her surgery.

"I don't sound exactly the same as I did," she says, "but to somebody who didn't know me before, I sound perfectly normal.

And those recorded messages and stories? Bourdon-Krause, now 39, with a second child, has burned them onto a cd for posterity.

 

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This article first appeared in the Fall, 2009 issue of Thrive.
Print Thrive Magazine; Fall, 2009