Brian Nussenbaum, MD, (left) and Jason Rich, MD, examine a model of the larynx, commonly called the voice box.
If Brian Nussenbaum hadn’t pursued a career in medicine, he would have become a math professor.
“In college, math classes were always my favorite,” said Nussenbaum, MD, the Christy J. and Richard S. Hawes III Professor of Otolaryngology. “But I also like science, and I like helping people. There aren’t many things you can do in life that combine science with directly helping people. Ultimately that’s what drew me to medicine.”
Though he acknowledges some fear in moving from formulas to fibulas.
“Math is generally not a traditional preparation for medical school,” he said. “It’s a different way of thinking that focuses on problem solving rather than memorizing facts. I was worried about how I might adjust to a different way of learning.
“Also, I was concerned I would faint when I saw my first human cadaver in gross anatomy class,” he said with a laugh.
Not only were his fears unfounded, he discovered an affinity for learning anatomy and was especially drawn to the intricate head and neck region of the body. This led to an early interest in otolaryngology — the ear, nose and throat (ENT) specialty.
“The anatomy of that area is just beautiful,” Nussenbaum said. “There are so many important structures in such a small, confined space — the swallowing and vocal structures, the inner ear, the upper airway, the cranial nerves. So much of the body’s physiology is controlled through this area. I was drawn to the detail and intricate nature of the anatomy.”
Making a choice
But even with this specific interest during his first two years of medical school, each rotation in his third year at New York University piqued his curiosity and left him with a desire to pursue whatever field he was immersed in at a given moment.
“I finished my internal medicine rotation, and I wanted to be a hematologist,” he said. “After general surgery, I wanted to be a trauma surgeon. And after OB-GYN, I wanted to be an obstetrician and deliver babies for the rest of my life. I really loved everything I did.”
What drew him back to his initial interest in otolaryngology was the unique ability to be involved with both medical and surgical aspects of care in one area of the body.
“If a patient has a bad sinus infection and needs antibiotics, the ENT prescribes that,” he said. “But if the patient needs surgery to open up the sinuses, you don’t send the patient to someone else to do that operation. You do it yourself. Few fields allow you to combine medicine and surgery in a single area of the body.”
His interest was further defined by a fourth-year internship at Mount Sinai Hospital in New York with two leading ENT surgeons who specialized in removing tumors of the head and neck. According to Nussenbaum, Mark Urken, MD, and Hugh Biller, MD, were among a few surgeons in the world at the time doing extremely complex reconstructive procedures after taking out the patient’s cancer.
“The type of surgeries they did I had never seen before,” he said. “I found it remarkable that they could remove two-thirds of someone’s jaw and tongue and then, 18 hours later, when the surgery was done and the reconstruction was done, the cancer was out and the patient still looked like himself.
“They could take a piece of the patient’s fibula bone in the leg and turn it into a new jawbone,” he said. “They might make the patient a new nose. It captivated me. Combining that with seeing their passion for taking care of patients with these life-threatening conditions, I decided this is what I wanted to do with my life.”
Head and neck surgeries are complex and at times lengthy, Nussenbaum said. Often, they are performed with a team approach. One surgeon removes the cancer, and another performs the reconstruction. They might remove three-quarters of the tongue to cut out the entire tumor. Then they’ll take tissue from the patient’s forearm and shape it in a way that forms a new tongue.
“Then we need to provide a blood supply in and out of the new tissue,” he said. “So we perform microsurgery where we stitch the arteries and veins together to provide new circulation. And after our job is done, these patients will go through speech and swallowing therapy and, often, further treatment with radiation and sometimes chemotherapy.
“Nowadays, nonsurgical therapies sometimes allow us to avoid these major procedures,” Nussenbaum said. “But when surgery is needed, it’s important to me that we’re not only helping cancer patients with life-threatening illnesses, but we’re able to restore form and function as much as possible. This aspect of the field still captivates me.”
After medical school, the New York native completed his residency at the University of Texas Southwestern Medical Center, where he happened to train under Robert McClelland, MD, one of the emergency room surgeons who attended to President Kennedy after his shooting in 1963.
“Dr. McClelland had a huge influence on my career development into an academic surgeon,” Nussenbaum added.
Later, Nussenbaum completed a two-year fellowship in head and neck oncology and reconstruction at the University of Michigan, where he performed basic research in tissue engineering, investigating ways to turn skin cells into bone-building cells. He joined the faculty of Washington University in 2002, where he also is his department’s vice chair for clinical affairs.
“One of the strengths that drew me here was the unique combination of a nationally renowned head and neck cancer program combined with the excellence of bone and mineral metabolism research,” he said. “If we can figure out a way to safely grow a new jawbone, that’s much better than cutting it out of the fibula and trying to shape a straight bone into a curved, complex shaped bone.”
In the lab, Nussenbaum has combined his interests in cancer and tissue engineering, studying the effects of bone growth factors on oral cancer cells to test the safety of this approach.
“The goal is always to improve care for the patients, but I think the kind of tissue engineering that would allow us to grow a new bone is still far down the road,” he said.
One way that Nussenbaum is helping patients today is in his role as patient-safety officer for the Department of Otolaryngology.
“On an administrative level, the work I enjoy the most is with patient safety and quality improvement,” he said. “I feel like I can make a difference at an individual level and at a university and hospital level as well. And not only does it benefit individual patients on a daily basis but lots of future patients to come.”
And despite not becoming a math professor, Nussenbaum is still a dedicated teacher, having been named teacher of the year in his department for five of the 12 years he has been at Washington University.
Nussenbaum and his parents, Philip and Bonnie, on vacation in Kona, Hawaii, in 2012.
When he’s not teaching, performing surgery, doing research or improving patient safety, Nussenbaum spends his little free time reading, exercising and cooking.
“I’m a foodie,” he said. “I love the St. Louis food scene. There are so many great restaurants.”
But Nussenbaum’s favorite restaurant is Alinea in Chicago, perhaps for reasons that appeal to the scientist, surgeon and head and neck specialist that he is. The restaurant’s owner and executive chef, Grant Achatz, specializes in molecular gastronomy, which harnesses the chemistry of food to create new flavors. Achatz is also a survivor of stage 4 tongue cancer. He won the James Beard Foundation Award for outstanding chef in 2008, despite having just undergone intensive cancer treatments, during which time he lost his sense of taste.
“I was interested in the restaurant before I found out he was a tongue cancer survivor,” Nussenbaum said. “I’ve met him a few times now. He wrote a book called "Life, on the Line." When you read about his passion for cooking and the training involved, it is very similar to the process of becoming a surgeon.
“It’s remarkable what these chefs can do on a scientific level — taking some unusual combination of ingredients and making them taste like something entirely different,” he said.
Indeed, as remarkable as a surgeon taking one part of the body and reforming it for an entirely new function.