Department of Otorhinolaryngology - Head and Neck Surgery

UT Health Medical School

ORL Progress Notes

ORL Progress Notes, our second on-line departmental newsletter, provides information about developments in the Department. The newsletter’s target audience includes physicians and health care professionals as well as patients and members of the general public.

The Watson Case: An “Impossible” Surgery Makes a Night-and-Day Difference for a Patient with Proteus Syndrome

AL-2By the time 39-year-old Ricky Watson saw Amber Luong, MD, PhD, FACS, he could no longer swallow, eat or talk. His only avenue of communication with his family was writing on a notepad or texting via cell phone.  Diagnosed at the age of 10 with Proteus syndrome, an extremely rare condition marked by overgrowth of bones, skin and other tissues, Watson had undergone numerous surgeries at institutions in East and West Texas in failed attempts to correct conditions caused by the syndrome.

“When Ricky was born, I knew something was wrong,” says Judy Watson, his mother. “I already loved him even before they handed him to me, but I noticed that his head was misshapen and his eyes were a little crossed. The doctors assured me that he was okay, just not the prettiest baby, and that these things are common in babies and improve over time.”  In cases of Proteus syndrome – only a few hundred have been reported in the world – organs and tissues grow out of proportion to the rest of the body. The overgrowth is usually asymmetric and can be disfiguring, as in the case of Joseph Merrick, a 19th-century Englishman who became known as the Elephant Man. The syndrome takes its name from Proteus, in Greek mythology, the prophetic old man of the sea who could change his shape at will.

As a child, Watson experienced developmental delays. The youngest of his parents’ three biological children, he was weaker than the others and late in meeting his developmental milestones.  “I took pictures of Ricky when he was a baby so his doctors could see how he’d changed over time,” Mrs. Watson says. “When he was about seven months old, I noticed that two of his toes on the left foot grew bigger than the others. Eventually his eyes corrected but his forehead was larger on one side than the other, and his right eye was larger than his left eye. When he was 22 months old, his doctors thought he had a brain tumor because one ventricle was larger than the other. They removed some tissue for a biopsy but the pathologist was stumped because he couldn’t identify it.”

In his early 30s he started developing nasal polyps and underwent three polypectomies. “We were driving back from Dallas one day and discovered a new polyp that continued to grow in his sinus,” Mrs. Watson says. “Our ENT in Longview trimmed it back as far as he could in three surgeries, each about a year apart. Ricky had always been able to swallow the biggest pill you could give him, and then all of a sudden he couldn’t take a little ibuprofen without it sticking in his throat. Then he worsened to the point that he couldn’t eat regular food and had to use a G-tube. He lost weight and grew weaker. Eventually, we couldn’t understand him when he talked. It was like he was wasting away.”

Large polyps can extend through the back of the nose and rest against the soft palate, causing symptoms of nasal obstruction and difficulty swallowing.

Large polyps can extend through the back of the nose and rest against the soft palate, causing symptoms of nasal obstruction and difficulty swallowing.

In November 2014, Watson’s neurologist in Longview, Texas, referred him to Dr. Luong in the Department of Otorhinolaryngology-Head and Neck Surgery at UTHealth Medical School. “He’d been seen by so many doctors and had undergone three polypectomies but no one would attempt to remove the large polyp that had grown from his sinus down the back of his mouth,” says Dr. Luong, an associate professor and director of research in the department, who also directs a laboratory at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases. “His left paranasal sinuses were completely blocked and a six-inch-long polyp was obstructing his airway and esophagus inlet. Sinus pressure was triggering debilitating migraines that forced him to stay in the dark of his closet. Unable to communicate except through writing, he was losing contact with his family. We believed we could help him.”

Mrs. Watson recalls her first meeting with Dr. Luong. “We were so thrilled with her nature,” she says. “She was compassionate, professional and respectful. When she said she could help Ricky, our whole family was thankful.”

With Watson’s dramatically abnormal asymmetry, the first challenge was getting a good CT scan of his sinuses. “The outside imaging his family brought in would be of no use in the OR because he’d been scanned as if his anatomy were normal,” says Elliott Friedman, MD, a clinical assistant professor in the department of Diagnostic and Interventional Imaging at UTHealth Medical School. “Ricky has extensive asymmetrical bone overgrowth involving the skull base. His right frontal sinus is large, and on the left side there is almost no frontal sinus, so positioning him for the scan was a challenge.”

The positioning hurdle was overcome through the skill and diligence of CT technologist David Huff. “He worked hard to get Ricky in the right position and was so patient and kind while he was doing it,” Mrs. Watson says. “The rest of the staff was going home. He was the only one left there but he didn’t act rushed. We appreciated that so much.”

CT images of Watson were acquired in a volumetric fashion, allowing for manipulation after acquisition. “By adjusting images of the transverse, sagittal and coronal planes, we can manipulate the data so that what the surgeon looks at on the scan is very close to what she is accustomed to seeing in the OR,” Dr. Friedman says. “Dr. Luong wanted to know what to expect during surgery. Our goal was to make a difference for the patient by giving her the information she needed.”

The second challenge came in the OR. “Our surgical navigation system requires an external emitter placed at the side of the head,” Dr. Luong says. “Patients are normally lying flat during surgery. We had to do some artful positioning to use the navigation system – and we absolutely needed it because of Ricky’s anatomy.”

When Watson came out of post-anesthesia after the three-and-a-half-hour surgery, he could talk immediately. “I was really happy with Dr. Luong,” he says. “She was so sweet the whole time. I was in terrible shape and couldn’t breathe. I had to sit up to sleep. I prayed for someone to help me because I was scared. I was thankful the Lord found someone for me, and I appreciate her so much.”
Mrs. Watson says the difference in her son’s quality of life is like night and day. “We’re happy to have the son we love back,” she says. “From his admission to his discharge, everyone we met along the way was professional, compassionate and just plain sweet to us – we never felt like we were cows coming through the chute. We felt confident that Ricky was in the very best hands.”

Ronnie Watson, Ricky’s father, describes the surgery as a “wonderful accomplishment. We are so thankful to God for Dr. Luong’s willingness to do it,” he says. “She certainly has a caring heart for people, and that’s what makes her special. God bless her.”

UT ORL Progress Notes Archives

  1. The Watson Case: An “Impossible” Surgery Makes a Night-and-Day Difference for a Patient with Proteus Syndrome
  2. Christian Conderman, MD joins UTHealth Otorhinolaryngology at its New Woodlands Location
  3. James Owusu, MD joins UTHealth Otorhinolaryngology at its New Woodlands Location
  4. New Clinical Learning Guidelines Transform How Medical Residency Programs Prepare Future Physicians
  5. TORS-L Eliminates the Need for Adjuvant Therapies in an Oropharyngeal Cancer Patient
  6. William Yao, MD joins Texas Sinus Institute and Texas Skull Base Physicians
  7. AAO-HNS President-elect to Speaks at 2015 Otorhinolaryngology Frontiers
  8. Surgical Fire Prevention in Laser Laryngeal Surgery
  9. A Gift of Hearing
  10. Breath of Fresh Air
  11. Current Pediatric Guidelines for Tonsillectomy
  12. Profile in Caring: José Elías, RN, CORLN
  13. Amber Luong, MD, PhD, Awarded CCTS Grant in Support of Continued Chronic Rhinosinusitis Investigations
  14. Two ORL Faculty Members Named to Top Doctor Lists
  15. Sialendoscopy: An Innovative Minimally Invasive Approach to the Treatment of Sialolithiasis
  16. Physicians’ Mission Satisfied
  17. A Second Pair of Ears
  18. Two ORL Faculty Members Receive Dean’s Teaching Excellence Award
  19. More Than 100 People Participate in UTHealth Otorhinolaryngology’s Annual Free Cancer Screening Clinic
  20. Etan Weinstock, MD, Selected Faculty Member of the Year
  21. Amber Luong, MD, PhD, Named Fellow of American College of Surgeons and Promoted to Associate Professor
  22. Memorial Hermann and UTHealth Welcome New Team Members
  23. Texas Hill Country ENT Symposium Recap
  24. Internationally Renowned Expert in Facial Cosmetic Surgery Speaks at 2014 ORL Frontiers
  25. Congratulations to Graduating Residents and Fellows
  26. Samer Fakhri, MD, Chairs Rhinology Program at Middle East Conference in Dubai, Serves as Invited Faculty in Tehran
  27. TORS-L: Transoral Robotic Surgery with CO2 Laser Offers Greater Precision for Surgeons and De-intensification of Adjuvant Therapies for Patients
  28. Reevaluating Anaplastic Thyroid Cancer: Aggressive Treatment May Extend Life and Improve Its Quality
  29. UTHealth Audiology Offers Widex Zen Therapy for Tinnitus Management
  30. MicroSeismic, Inc. Gives Pediatric Patients the Gift of Hearing
  31. In Memoriam: Robert Jahrsdoerfer, MD
  32. Simultaneous Bilateral Cochlear Implants in an Infant After Meningitis
  33. Laryngotracheal Reconstruction Using Anterior Cricoid Suspension in a Three Year Old
  34. Single-Incision Minimally Invasive Parathyroidectomy
  35. Advanced Technology and a Strong Focus on Convenience Improve the Patient Experience
  36. Multidisciplinary Virtual Pre-surgical Planning Optimizes the Outcome for an Ameloblastoma Patient
  37. Dr. Fakhri Receives Regents’ Outstanding Teaching Award
  38. IL-33-responsive Innate Lymphoid Cells Are an Important Source of IL-13 in Chronic Rhinosinusitis with Nasal Polyps
  39. Randomized, Double-Blind, Controlled Trial of Oral Antifungal for the Treatment of Fungal-sensitive Chronic Rhinosinusitis with Nasal Polyps
  40. Dr. Fakhri Promoted to Professor of Otolaryngology-Head and Neck Surgery
  41. TLR4 Signaling in the Pathophysiology of Allergic Fungal Rhinosinusitis
  42. Two ORL Faculty Members Named to Texas Super Doctors 2013 List
  43. Transoral Robotic Surgery for the Treatment of Obstructive Sleep Apnea
  44. Lone Star Rhinology Course Attracts a National Audience
  45. Internationally Renowned Otolaryngologist Speaks at 2013 ORL Frontiers
  46. ORL Welcomes New Recruits
  47. UTHealth Otorhinolaryngology Holds Free Cancer Screening Clinic
  48. Two ORL Team Members Named Fellows of the American College of Surgeons
  49. Faculty Named Among Texas Super Doctors Rising Stars
  50. Two ORL Faculty Members Receive Dean’s Teaching Excellence Award
  51. Translational Science Program Working to Identify Therapeutic Targets in Chronic Rhinosinusitis
  52. Preventing Surgical Fires: UTHealth Otolaryngologist Provides Expert Advice for a New FDA Safety Initiative
  53. Improving Survivorship in Head and Neck Cancer: UTHealth Department of Otorhinolaryngology and Institute of Molecular Medicine Partner on CPRIT Research Award
  54. Using Intraoperative Staining to Identify the Parathyroid Adenoma
  55. Otorhinolaryngologists Named to 2012 Best Doctors in America List
  56. Four Studies Evaluate the Effectiveness of Optical Rhinometry
  57. A Collaborative Approach Offers Patients a Less Invasive Alternative for Surgical Excision of Pituitary Tumors
  58. Internationally Renowned Otolaryngologist Speaks at 2012 ORL Frontiers
  59. Ron Karni, MD, Selected Faculty Member of the Year by Graduating Residents
  60. Samer Fakhri, M.D., Receives AAO Foundation Honor Award
  61. Two Audiologists Join UTHealth Otorhinolaryngology
  62. 2012 Residency and Fellowship Update
  63. Five UTHealth Medical Students Matched to Top Choice Otorhinolaryngology Residency Programs
  64. Two ORL Faculty Members Receive Dean’s Teaching Excellence Award
  65. Chair of Otorhinolaryngology Named to Texas Super Doctors 2012 List
  66. Minimally Invasive Surgery for Skull Base Cancer
  67. UTHealth/Memorial Hermann Physician Joins a Medical Mission to Honduras
  68. Online Patient Access Library Offers Medical Information About ENT Diseases & Conditions to Patients
  69. Facial Reanimation Surgery Brightens a Young Boy’s Future
  70. Morphoproteomics: Driving a Shift to Personalized Care for Sinonasal Undifferentiated Carcinoma
  71. Internationally Renowned Otolaryngologist to Speak at 2012 ORL Frontiers
  72. UTHealth Otorhinolaryngology Department Exceeds the National Averages in Quality and Safety
  73. Rhinologist Invited to Serve as Board Examiner in the Middle East
  74. Dr. Citardi Named to the 2011 Texas Super Doctors List
  75. Make Your Voice Count!
  76. Research Update
  77. Advanced Rhinology Concepts CME Attracts a National and International Audience of Otolaryngologists
  78. Outside the Box with Chronic Rhinosinusitis
  79. The Vargas Case: Excision of a Large Benign Goiter
  80. The Reverend Williams Regains His Voice
  81. Nihal Uddin’s Journey to 360-Degree Hearing
  82. Residents Receive Research Grants
  83. Two ORL Faculty Members Receive Dean’s Teaching Excellence Award
  84. Otorhinolaryngologists Named to Best Doctors in America List
  85. Russell Kridel, MD, Reelected to AMA Council Position
  86. From Bench to Bedside: Physician Researcher Amber Luong, MD, PhD Blends Basic Science with Clinical Care
  87. 2011 Advanced Rhinology Concepts Scheduled for November
  88. Internationally Renowned Otolaryngologist Speaks at 2011 ORL Frontiers
  89. Michael Byrd, MD Recruited to UTHealth and Memorial Hermann
  90. UT Physicians Opens Facial Plastic Surgery Clinic in Southwest Houston
  91. UTHealth Audiology Program Expands
  92. 9 UTHealth Medical Students Match in Otorhinolaryngology
  93. Residency and Fellowship Update
  94. Ron Karni, MD Invited to Speak in Panama
  95. Finding the Unknown Primary in Head & Neck Cancer
  96. A Meta-Analysis of Topical Amphotericin B for the Treatment of Chronic Rhinosinusitis
  97. Cytokine Profile Comparison Between Inflamed Sinus Mucosa and Sinonasal Polyps from Chronic Rhinosinusitis
  98. The Distribution of Normal Saline Delivered by Large-Particle Nasal Nebulizer versus Large-Volume/Low-Pressure Squeeze Bottle
  99. Averting the "Limping Larynx" with a Multidisciplinary Approach
  100. Repair of Nasal Obstruction with Functional Septorhinoplasty
  101. Definitive Endoscopic Resection of Inverted Papilloma
  102. Facial Reanimation and Facelift for Facial Paralysis
  103. Mometasone Furoate Gel: A Novel In-Office Treatment of Recalcitrant Postoperative Chronic Rhinosinusitis
  104. Rhinologic Applications of Radiofrequency Coblation
  105. Rhinoplasty for Nasal Obstruction
  106. Producing Quality Outcomes in Thyroid Surgery
  107. Functional Rhinoplasty: Repairing Nasal Valve Obstruction
  108. A Cancer Patient Regains His Voice
  109. Soham Roy, M.D., Named Director of Pediatric Otorhinolaryngology
  110. From Bench to Bedside with New Treatments for Chronic Sinus Disease
  111. Comprehensive Rhinology Program Offers State-of-the-Art Care for Patients with Chronic Rhinosinusitis Refractory to Standard Treatments
  112. Rhinology Update: Advanced Rhinology Concepts CME Scheduled for November
  113. The Comprehensive Voice Program: From Advanced Office-Based Procedures to Community Outreach
  114. Designing the Future: ORL’s New Office Space Features High-Tech Tools
  115. Welcome!

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ORL Update UT ORL Update, our first on-line departmental newsletter, summarizes current topics in otorhinolaryngology. The newsletter’s target audience includes both physicians and other healthcare providers, although subscriptions are not limited to members of these groups.

ORL Progress Notes ORL Progress Notes, our second on-line departmental newsletter, provides information about developments in the Department. The newsletter’s target audience includes physicians and healthcare professionals as well as patients and members of the general public.

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