Supersize Me

This is going to be a very insensitive post – those people who can’t take jokes shouldn’t read on.

I’m sure you all know the sitcom Scrubs. It has finished its 6th season in the US and I’m dying for more of JD and Turk. I remember not too long ago, somewhere in season 5, episode 2, there was something about sucking up to lame jokes. JD asked his interns to check out a CT scan and said, ‘his tumour’s getting so big, it’s starting to look like a threemour.’ LAME you think.

So instead of threemour, how about a fifteenmour? This bloke has the largest ever neurofibroma ever recorded. Weighing in at 15kg, this massive tumour on his face is due to be surgically removed. It has grown larger and larger and larger since he was a kid and he never had the common sense to get it removed earlier.

If you watch the video clip, you’ll see that he has severe kyphosis due to the sheer weight of the thing. Surgeons say they’ve successfully removed 2 facial tumours of the sort in Southern China but they say this one was still going to be tough, commenting on the numerous vessels in the tumour.

Neurofibromatosis is a autosomal dominant condition subdivided into type 1 and 2. In type 1 (90% of NF), multiple neural tumours form under the skin and used to be known as von Recklinghausen disease. They are generally discrete, uncapsulated nodules that are soft to touch. Overlying skin is often hyperpigmented. These tumours can arise at ANY site on the body.

In 3% of patients, the benign neurofibroma turns into a malignant neoplasm and can be life-threatening. These patients are also at higher risk of getting other tumours – glioma, meningioma, phaechromocytoma (I love that name…). 30-50% also see associated skeletal lesions like scoliosis, bone cysts and other erosive bone defects.

So what’s gonna happen to this dude? I have no idea. They’re probably gonna resect the tumour which is likely to have arisen from either the facial nerve or branches of the trigeminal nerve. Loose skin would definitely have to be cut off and he might lose some of the facial muscle function because muscles of facial movement are attached to the skin and I have no idea how they can preserve that function.

On a side note, here’s a good video of a total parotidectomy with facial nerve preservation: it’s quite cool! And, I didn’t know the branching of the facial nerve into the superior and inferior branches outside the stylomastoid foramen was called the pes anserinus. Pes anserinus means goose foot and I believe it refers to a structure on the medial tibia as well – where the gracilis, sartorius and semitendinosus muscles are attached.

References:
Kumar et al (2003), Robbins Basic Pathology 7th ed, Saunders
The Straits Times Website