Pamela Klusack is in the business of love. She performs weddings, leading happy couples into wedded bliss. So when a tickle in her throat and dry cough began to impact her work, she didn’t hesitate to see her doctor.
It took five years and five physicians to determine that Pamela’s right vocal cord was the culprit of her problems. “The third ENT noticed a cyst on my right vocal cord and immediately referred me to Dr. Hogikyan,” Pamela says.
In February 2012, Norman D. Hogikyan, M.D., FACS, performed a laryngeal videostroboscopy, revealing an abnormal mass severely distorting the majority of her right true vocal cord. The nature of the mass could not be determined by office evaluation alone, so a CT scan was ordered.
The results demonstrated a large submucosal cartilage-based mass of the thyroid cartilage of the larynx. Dr. Hogikyan performed an endoscopic biopsy of the mass. To everyone’s surprise, the biopsy determined the mass to be an osteoblastoma of the thyroid cartilage – an extremely rare lesion.
“As the saying goes, Pamela was treated for several different horses, but it turned out she had a zebra the whole time,” Dr. Hogikyan says.
Faced with a rare diagnosis and a patient who relied heavily on her voice in both her personal and professional lives, Dr. Hogikyan had a difficult decision to make.
“This tumor was fundamentally benign but behaved much like a cancer in terms of how it disrupted the framework of her larynx,” Dr. Hogikyan says. “Completely resecting the tumor while trying to preserve laryngeal function presented a tremendous surgical challenge. We needed to tailor an operation to include aspects of a laryngeal cancer resection and yet attempt to preserve vital voice-producing internal laryngeal structures.”
Pamela was up for the challenge, understanding the surgical team would enter surgery not knowing exactly what needed to be resected to remove the tumor.
"I knew it might not work, but I at least had to try. I am so thankful Dr. Hogikyan understood how important my voice is to me and was willing to think outside of the box,” says Pamela.
Dr. Hogikyan approached Pamela’s tumor through the neck, like he would for a partial laryngectomy for cancer. He dissected the internal laryngeal structures off the cartilage framework to preserve them before resecting the tumor and associated cartilage. A key determinant of her voice outcome would be whether he could maintain proper attachments of her vocal cords to the remaining laryngeal framework. The margin of the tumor was very close to a vital point at the front of the larynx. By designing incisions that encompassed the tumor but maintained key attachment points, the vocal cords and vocal function were preserved.
“It was an exciting moment in the operating room when we had the tumor free and could see that the voice-producing structures were intact,” Dr. Hogikyan says.
Today Pamela is back to doing weddings, with her voice intact.
“Pamela brings much joy to couples through her professional work. It is very gratifying for me to see her return to and thrive in her profession,” Dr. Hogikyan says. “This is what we hope to do as physicians and surgeons – enable patients to move on from a disease or injury and live life as it was meant to be for them and for their families. I like to think Pamela’s operation is representative of what we call the Michigan Difference here at U-M.”