JoAnn Selvera

JoAnn Selvera was stuck in a waiting game. A small lump she had noticed in the back of her throat was slowly growing. Selvera was scared of what could happen if she didn't do anything about it. But she was even more afraid of what would happen if she did. She had been told that removing the growth would leave scars on her face and a large hole in the roof of her mouth. To Selvera, that sounded worse than the lump.

So Selvera waited, and the lump kept growing. One of her sisters began searching the Internet for options. There, she found information on Oral and Maxillofacial Surgery at Mayo Clinic. She sent an e-mail describing Selvera's situation and asking for help. The next day, the phone rang. It was Deepak Kademani, D.M.D., M.D., a surgeon at Mayo Clinic in Rochester, Minn. Selvera's wait was over.

Searching for better options

Before the lump in her throat appeared, Selvera hadn't had any serious medical problems. Her work as a quality technician for a manufacturing company and the activities of her large, close-knit family in their hometown of Bennington, Neb., left little time, or need, to worry about her health. That all changed with the lump.

She first went to an oncologist in Omaha. A biopsy revealed her condition to be pleomorphic adenoma, a slow-growing, noncancerous tumor of the salivary gland. The doctor advised Selvera to have surgery to remove it. To ensure the tumor didn't come back, he recommended removing a significant amount of tissue around it, leaving a hole.

Selvera took some time to consider this advice, and then she went to a surgeon for another opinion. Meanwhile, the tumor grew. It extended from the back of her throat, through the bone in the roof of her mouth and into her nose. The surgeon also suggested surgery. But the side effects he described were more serious. Because the tumor was so large, it would have to be extracted through incisions on Selvera's face. When the surgery was over, Selvera would have a hole inside her mouth that opened into her nasal cavity. She wouldn't be able to speak clearly and she wouldn't be able to eat unless the hole was covered with a permanent plate. On top of that, her physicians cautioned Selvera that even if she had the surgery, there was a high risk the tumor would come back.

"When they explained what would happen to me, there was no way I was having that surgery," says Selvera. "Quality of life was an important consideration. I decided I'd rather have nothing done at all."

Gaining new hope

Selvera continued searching for a surgeon who could offer something better, but without success. Her situation deteriorated. As the tumor grew, it began to cut off her air supply. She couldn't breathe out of one side of her nose, she suffered headaches and she couldn't sleep well.

Then her sister found Mayo Clinic's Web site, and contacted the Division of Oral and Maxillofacial Surgery. When Dr. Kademani phoned the next day, suddenly Selvera had new hope.

"He talked to me and to both of my sisters separately about my situation," she says. "He took time to really understand my problem. He has a calming voice; he put me at ease."

After talking with Selvera and her sisters, Dr. Kademani encouraged Selvera to come to Rochester for an evaluation. "The e-mail I received from Selvera's family seemed desperate," says Dr. Kademani. "After talking with them, I was convinced we could help."

Meeting the challenge

When Selvera met with Dr. Kademani in Rochester, she was relieved to find his treatment goals matched hers.

"He told me that after we were finished, he wanted me to be able to go to a restaurant, order on my own, talk to the people around me, enjoy my food, and just do the normal things people do when they go out to lunch — the stuff we all take for granted," says Selvera. "I was thrilled when he said he could make that happen."

Dr. Kademani proposed doing the entire surgery through Selvera's mouth. Rather than leaving a hole behind when the tumor was extracted, he would call on the expertise of a colleague Steven Moran, M.D., a Mayo Clinic plastic surgeon. Dr. Moran and his team would use skin from Selvera's forearm to reconstruct the roof of her mouth, allowing her to talk, eat and drink normally. Finally, Dr. Kademani was confident he could remove the entire tumor at once, dramatically decreasing the chance of it coming back.

"This type of tumor is common in the head and neck," says Dr. Kademani. "But, its size and location made it difficult. I was able to gain access to the tumor by moving her upper jaw out of the way and going through her palate, so I could remove the entire tumor in one piece."

Reaping the benefits

Selvera agreed to the procedure and underwent the complicated surgery at Saint Marys Hospital. The surgical team was able to successfully remove the grapefruit-sized tumor and reconstruct the roof of Selvera's mouth all in one operation. Ten days after the surgery, she was able to go home.

Although the risk of the tumor coming back is low, Selvera's medical team at Mayo continues to monitor her closely to ensure there's no recurrence. At her three-month checkup, the only evidence of her ordeal was a nasal tone in her voice, which continues to fade as she heals. She can now breathe, eat, drink and talk normally.

To indicate the difference her treatment has made in her life, Selvera spreads her arms wide. "Before all this, I had heard the name 'Mayo Clinic,' but I didn't know much about it," she says. "Now, I know that without Mayo Clinic, I would have lost hope. Dr. Kademani and his team were amazing. It made all the difference to have a doctor who had seen this kind of thing before. I went from no quality of life to a whole life ahead of me."