Like a frequent marathoner who takes the miles in stride, head and neck surgeon Terry Su, MD, DDS, practices a rhythm of endurance and recovery.
In procedures that can take 10 to 14 hours, he works with a plastic surgeon to remove tumors of the mouth, jaw or neck, then perform reconstruction using skin and bone from the lower leg. The process includes microsurgical work to connect arteries and veins that integrate the grafted tissues.
"The next day, I'm completely exhausted," Su said. "But at this point in our lives, we're still relatively young. We can do a surgery like that on a Monday, and by the following Monday I'd be ready for a big surgery again."
Su typically tackles only one or two such extensive procedures a month, as part of his practice with Osceola Plastics & Maxillofacial Cosmetic & Reconstructive Surgery alongside plastic surgeon Luis Jaramillo, MD. Ordinarily, advanced reconstructive procedures are limited to academic centers, Su said.
"When you have two or three residents helping out, it makes both the procedure itself and the rounding afterward easier to manage," Su said. "Since these patients are usually in the hospital for a week or two, and we are also taking care of them during that time, we are limiting what we do right now."
Still, Su said he has been glad to help address what he's found to be a regional shortage of head and neck surgeons who do cancer surgery. He has been part of the Osceola Regional Medical Center affiliate practice for the past three years.
"Central Florida is very underserved in terms of head-and-neck cancer surgeons," he said. "We've seen patients being sent to Miami, Tampa or Jacksonville. Even as this area continues to grow, there are not a lot of surgeons doing what I do. And a lot of primary physicians are not aware that there are surgeons available locally to do these surgeries."
A native of northern California, Su came to Florida for a fellowship in head and neck surgery and microvascular reconstructive surgery at the University of Florida College of Medicine-Jacksonville. He chose to stay in the state after his fellowship and accepted the position in Orlando.
Su had initially pursued a career in dentistry. He completed dental school at New York University and returned to San Francisco to begin practicing. A few months in, however, he decided dentistry was not for him.
His choice to return to medical school and focus on oral and maxillofacial surgery allowed him to redefine his career while still tapping his dental training.
"Many of our patients are referred from dentists, and my background helps me better relate to dentists," Su said. "Dentists are important partners, because they are usually able to spot cancers pretty early. If you go for a dental cleaning twice a month, you should also be getting oral cancer screening exams at each visit. Something that's 1 cm in size is pretty obvious in the mouth."
On the medical side, Su said, many primary care physicians do not have the same opportunity or awareness to catch mouth cancers early.
"I've had patients who have had ulcers on their tongue for six or seven months, who've been treated with multiple rounds of antibiotics and steroids as the ulcers keep getting bigger," he said. "It's important for physicians to know that if there is any lesion in the mouth that doesn't heal in two or three weeks, something is not right. It really needs to be biopsied."
Su said that when such cancers are given six or seven months to grow, there's a far greater chance that they will metastasize to the lymph nodes, reducing a patient's chance for survival.
"We know that if we are able to diagnose and treat this cancer at Stage I, when it is relatively small and confined, the survival rate approaches 90 percent," he said. "However, a lot of times, when these patients come to me at Stage III or IV, the five-year survival rate is only 35 percent."
Because of the aggressive nature of malignant tumors and even many benign tumors of the head and neck area, Su takes an aggressive surgical approach. In most cases, he removes not only the tumor but also surrounding normal tissue to ensure the entire tumor is gone.
"Often, this leaves the patient with a big defect that can be very debilitating if it is not reconstructed properly," he said. "For a tumor in the upper jaw, we may have to remove half of the jaw, so you have to put bone and soft tissue back. In getting bone and some skin from the lower leg, and connecting the arteries and veins under the microscope to reestablish blood flow to the flap, we are able to rebuild a jaw."
Similarly, Su said, soft tissue flaps harvested from other parts of the body can be used for reconstruction after surgery to remove a cancer of the tongue.
"The goal is not only to restore form -- aesthetically, you want to make it as comparable as you can -- but also to restore the function of the structures you remove," he said. "If someone has to have a tongue cancer removed, you want to rebuild the tongue to make sure they're still able to speak and to swallow."
For Su, the reward in being able to provide such procedures includes both the surgical challenges they offer and the relationships he forms with patients. He continues to follow up with patients regularly even after they have completed radiation and chemotherapy.
"As long as they're survivors, I still see them for routine cancer surveillance appointments," he said. "Knowing the patient for over a year, you really do develop a close relationship with them."
Su's areas of interest also include salivary gland pathology, microvascular reconstruction of complex deformities of the bony and soft tissues of the face, and cranio-maxillofacial trauma.
He holds a medical degree from the University of California, San Francisco, and completed his oral and maxillofacial surgery residency, including a year of general surgery internship, at the University of California San Francisco Medical Center. He is board eligible with the American Board of Oral and Maxillofacial Surgeons and is a member of the American Association of Oral and Maxillofacial Surgeons.