Anxiety Management Plays a Key Role in Successful Surgery

Criss Ann Valenti was in biology class when she felt a weird lump on the right side of her face. She immediately panicked, but after talking with her parents (mom Donna and dad Brent) they all agreed to monitor it for a bit.

When Criss Ann began experiencing some pain with yawning or talking for long periods of time, they decided to seek medical care.

Brent Valenti was already a patient of Sanford Timen, MD, a Cleveland Clinic otolaryngologist, so they scheduled an appointment with him.

Criss Ann has a history of getting highly anxious in stressful situations and had been diagnosed previously with vasovagal syncope – a reflex reaction to what is happening around you that results in a sudden drop in blood pressure and heart rate causing you to pass out or faint. As a result, there was concern about how her anxiety would impact the appointment, especially when Dr. Timen wanted to remove a sample of the lump using a large gauge needle.

“Criss Ann doesn’t like needles, but she told Dr. Timen to go ahead. With one poke of the needle, he was able to remove the cells he needed. She did great,” says Brent.

Biopsy results of the cells were inconclusive, and in the hope the lump could simply be a resolving lymph node, the decision was made to monitor things a bit longer. A follow-up MRI exam showed that while the lump on Criss Ann’s face didn’t appear any larger, it had in fact gotten bigger on the inside, growing closer toward the facial nerve.

“That’s when we decided it needed to come out,” says Brent.

Dr. Timen referred the Valentis to Cleveland Clinic pediatric otolaryngologist Brandon Hopkins, MD, surgical director of the Pediatric Center for Airway, Voice and Swallowing (PCAVS).

Within just days, an anxious Criss Ann was in his office. “The assistant who was checking her in did a lot of pushing and prodding of the lump. I told him he might want to stop, but when Dr. Hopkins came into the exam room, Criss Ann was passed out in the chair,” says Brent.

“I don’t remember everything that happened before surgery, but right before fully going out, I remember things being very fun.”

Despite that rough start, Dr. Hopkins was able to clarify the diagnosis. Criss Ann had lymphangioma, a vascular malformation that could be removed via parotidectomy surgery.

“The condition, in which normal cells are in abnormal positions, is something she was born with. Until something happened – likely a bacterial infection – the cells couldn’t be felt or seen. Swelling from the infection made the malformation apparent,” explains Dr. Hopkins.

While parotidectomy surgery to remove the lump was risky because of its proximity to the facial nerve, it was not extremely urgent that it be removed. Being able to postpone surgery was important to Criss Ann, who was in the midst of her final season on the golf team at North Royalton High School.

A team co-captain, Criss Ann didn’t want to cause concern, so she told very few people about the surgery that was planned for Friday, October 14. The team had a great season, advancing to sectionals, then districts, to be played on Thursday, October 13.

“At that point, I had to tell the coach. I asked what would happen if it rained on the 13^th, and he said it would be moved to the 14^th. I said, well…I have this surgery happening,” says Criss Ann. Fortunately, the district match was played as scheduled.

Upon arrival for surgery, the Valentis were met by members of Cleveland Clinic Children’s Child Life Services team who would help Criss Ann manage her anxiety using techniques such as distraction, guided imagery and relaxation exercises.

“Everyone was comforting and patient, they put me at ease. A nurse played music that I liked – it was blaring down the hall. I don’t remember everything that happened before surgery, but right before fully going out, I remember things being very fun,” says Criss Ann.

The surgery went very well, with Criss Ann going home the next day. Her facial nerve was fine, and tissue biopsy was benign (non-cancerous).

A few days later, the Valentis scheduled an unplanned follow-up visit with Dr. Hopkins due to concerns about swelling in the area where the lump had been.

“Turned out that it was just us being worry warts. Everything was fine,” says Brent. “Fortunately for us, Dr. Hopkins didn’t mind. He’s very thoughtful and caring. Over time, he responded to our many questions asked via MyChart, and even had me call him on his personal cell a few times.”

Now preparing for high school graduation and the start of college, Criss Ann was the very first recipient of a new award from the North Royalton High School golf team – the courage and commitment award.

“She worked hard physically and mentally throughout this whole process,” says her proud dad.