The surgeon who removed 80% of Muzamil's tongue

From a swollen tongue to an operating table

The episode opens with Muzamil speaking at roughly 80% of his normal pace, still recovering, and immediately flagging it for the audience. He thanks listeners for their patience and well-wishes before introducing his guest: “आज हमारे साथ मौजूद है بہت بہت ہی خاص مہمان — doctor Uzair Luqman.” The framing is unusual for a podcast. This is not a guest who has come to promote a book or a company. He is the man who operated on the host four and a half hours earlier in the month.

Dr. Uzair Luqman is a consultant oral and maxillofacial surgeon with fellowships from the Royal Colleges of Surgeons of Ireland, Edinburgh, and Glasgow, and additional training at a military hospital in Germany. He opens by acknowledging that getting him to speak openly about the case was not easy — “آپ سے اگلوانا کتنا مشکل تھا ہمارے لیے” — and the conversation that follows is one of the more candid medical discussions to appear on the show.

Growing up in a military family, finding an identity at Government College

Dr. Luqman grew up in Lahore in a military household, attended Government College Lahore for his FSC between roughly 1999 and 2001, and then moved into the hostel when his father was posted to Rawalpindi. He describes the moment his father called to ask how things were going, and his answer: “یہ پہلی دفعہ زندگی میں ایسا ہوا ہے کہ میں son of so-and-so کے نام سے نہیں بلکہ اپنے نام سے لوگ مجھے پکار رہے ہیں.” For the first time, he was an individual rather than an officer’s son.

Muzamil connects this to a broader point about institutions. He notes that most young people today would choose the flashier walls of a private school over Government College, but that the weight of the names who walked those corridors — poets, intellectuals, public figures — is a kind of power that very few people appreciate anymore.

Why dentistry, and why surgery specifically

Dr. Luqman chose BDS over MBBS deliberately, not by default. He pushes back on the widespread Pakistani assumption that a “real doctor” is an MBBS doctor and that dentistry requires less effort. His reasoning is simple: a teacher once told him that only the number one matters — two through fifty are all equal, all compromises. “آپ کی جو first choice ہوتی ہے وہی آپ کی چیز ہوتی ہے.” He had visited dental clinics as a child and liked what he saw. That was his number one.

The pivot toward surgery came during the 2005 earthquake. He was on a surgery rotation when the patients arrived. “Surgery جو ہے وہ ایک ایسی specialty ہے جو کہ آپ دکھی انسانیت کی true sense میں خدمت کرتے ہیں.” He decided then that if he could not get into surgery, he would open a quiet general dental clinic somewhere and leave it at that. He got into surgery. He completed his FCPS specialisation in oral and maxillofacial surgery by late 2011, then spent the following years accumulating fellowships and training abroad, including a stint at a military hospital in Germany — a country whose precision and punctuality he found deeply compatible with his own perfectionism.

What oral and maxillofacial surgery actually covers

Muzamil asks Dr. Luqman to explain the specialty to a general audience, because most people associate dentists with a calm clinic and a gentle cleaning, not with trauma bays and cancer wards. Dr. Luqman defines the domain as everything from the hairline to the collar bones — all the bony framework of the face, the jaw, the neck — plus the oral cavity. The work divides roughly into trauma (road accidents, sports injuries, falls), cancers, congenital facial deformities in children, and benign lesions like the one Muzamil had. He also continues to perform implants, root canals, and bone augmentation procedures because the dental foundation never disappears.

Pakistan, he notes, is among the highest cancer-producing countries in the world, which means a significant portion of his caseload involves malignancies of the mouth, jaw, and neck.

The diagnosis: an arteriovenous malformation taking over a tongue

Muzamil describes how it started: cuts appearing on the left side of his tongue, a swelling he assumed was a post-extraction infection, a friend who was a dentist telling him this was not normal, and then his wife — also a dentist who had previously worked with Dr. Luqman — suggesting they go to him directly.

Dr. Luqman received a photograph first. When Muzamil came in, he examined the tongue manually and felt something beneath the surface. He inserted a needle to aspirate — checking whether what was inside was pus, clear fluid, blood, or air. The result was inconclusive but alarming. He ordered an MRI.

The MRI revealed an arteriovenous malformation: a tangle of abnormally enlarged blood vessels that had formed during development, when local growth signals became distorted and caused a cluster of vessels to overgrow. These lesions grow alongside the body, flare dramatically at puberty during the final growth spurt, and then may lie dormant until a trigger — a minor infection, an illness — causes them to flare again. “Basically آپ کا یہی problem تھا اور وہی آپ کی almost on average latest stage پر بھی present کر جاتے ہیں.”

The MRI images, which Dr. Luqman walks through on camera, show the lesion occupying 75 to 80% of the tongue’s total volume. The remaining normal tissue is a thin shell. In one image, the lesion is visibly pushing against the airway. If it flared further, it would close off breathing entirely.

The surgery: four and a half hours, land mines everywhere

Muzamil had consulted an interventional radiologist and a plastic surgeon before committing to the procedure. Everyone agreed surgery was unavoidable. The question was approach. Dr. Luqman explains three options: cutting in from the neck below, splitting the jaw open like a bat wing for full access, or working entirely through the mouth. He chose the third, with the neck as a fallback.

The evening before surgery, an interventional radiologist performed an embolization — threading a catheter up to the tongue’s main feeding vessels and blocking them. The window is narrow. The body detects the blockage within hours and begins rerouting blood supply. “آپ کو یہی کرنا ہوتا ہے بڑا اچھا time کرنا ہوتا ہے interventional radiologist کے ساتھ کہ وہ کرے اور چند گھنٹوں کے اندر ہی آپ جا کے surgery کر لیں ورنہ وہ کوئی اور path بنا کر.” Surgery began the next morning.

The operation took four and a half hours. The lesion was adherent — stuck to surrounding tissue — which meant working slowly around nerves that had been pushed to the walls of the tongue as the malformation grew. “ہر طرف nerves ہیں۔ So you have land mines all around.” The team had pre-planned for three contingencies: catastrophic intraoperative bleeding requiring carotid ligation, post-operative swelling requiring a tracheostomy, and prolonged intubation on a ventilator if swelling threatened the airway without major bleeding. None of the contingencies were needed. The lesion came out in one piece. No vital structures were damaged.

Waking up: the ICU, the oximeter, and learning to speak again

Muzamil describes the recovery with unusual candour. He had not thought much about the risks going in — he was mostly worried about a visible scar on his throat. The reality of what he had agreed to only landed when he was already on the stretcher. “اس point کے اوپر I just like — دیکھ لیں آپ کے سر پر یہ ہے کہ یہ کیا ہونے والا ہے.”

He woke up with his tongue swollen so severely it was protruding from his mouth. He could not position it. He felt he could not breathe. The team kept telling him the oximeter showed he was fine. He was not convinced. He eventually found one position in which breathing felt manageable and held it. In the ICU that night, every time he drifted toward sleep his pulse oximeter would drop to 85% and begin beeping, his heart rate would fall below 50, and he would jolt awake. He was alone — ICU rules do not allow attendants. “مجھے بس یہ ڈر تھا کہ یار یہاں پڑا پڑا مریا تو کیا ہو جائے گا؟”

Dr. Luqman explains that this was the intended outcome. The team had decided not to put Muzamil on a ventilator or perform a tracheostomy. An awake patient can self-position to maintain their own airway. The monitors were being watched. The beeping was information, not crisis. On the third day, Dr. Luqman visited and kept asking Muzamil to say his own name. He refused. Then, reluctantly, he said something. “اور اس کے بعد پھر yeah that journey started.” The tongue, he explains, has to relearn. The mild speech difference Muzamil still has at the time of recording will continue to improve as the tissue adapts.

What Pakistani medical education gets wrong about patients

One of the more pointed exchanges in the conversation concerns soft skills. Muzamil notes that almost every Pakistani doctor he has encountered is dismissive — patients are ping-ponged between specialists, given no context, and left confused. He credits Dr. Luqman as one of two or three doctors in his entire life who walked him through the process honestly, including the risks, rather than simply saying “سب ٹھیک ہو جائے گا.”

Dr. Luqman’s response is direct. Pakistani medical education focuses entirely on procedure and information transfer. “جو grooming element ہے اس میں بالکل بھی focus نہیں ہے۔” Medical law, medical ethics, how to communicate with a patient as a human being — none of it is formally taught. Doctors learn it, if they learn it at all, on their own. He uses a driving analogy: Pakistani doctors know how to steer the car but have never been taught the rules of the road. You can drive, but you cannot function in a system that requires you to follow those rules.

He also frames the problem structurally. Accountability in Pakistan is weak. The lowest level of ethical behaviour — acting correctly because you fear punishment — is largely absent. What remains is conscience, and conscience varies. Empathy, the ability to place yourself in the patient’s position and ask what they are experiencing, has to be cultivated deliberately. Doctors are overworked, the patient load is enormous, and the system does not reward the time it takes to sit with someone and explain what is happening to them.

Prevention: what people should actually be doing

Muzamil asks Dr. Luqman what people in Pakistan should be monitoring and how often. The answer covers two categories.

For trauma, the message is simple: wear a helmet and proper gear. Pakistan has not internalised safety culture. Other countries were printing “safety first” pamphlets in the 1940s and 1950s. The bulk of maxillofacial trauma cases are preventable.

For cancers, the critical variable is stage at presentation. Stage one and two survival rates sit at 75 to 80%. Stage four drops below 10%. The jump between stages can happen in weeks. “جب تکلیف شروع ہوتی ہے تو اس وقت وہ پورا جواب دے چکا ہے۔” By the time pain drives someone to a clinic, the disease has already progressed. The solution is regular visits — treating the body the way you treat a car, with scheduled maintenance rather than emergency repairs. Smoking and niswar are directly correlated with oral cancers. Other chemical and plastic-related factors are increasingly being identified. Muzamil’s case, Dr. Luqman clarifies, was not in this category — the AVM was a developmental anomaly, not a lifestyle-related cancer.

Pakistan in 2050, and the case for staying

By the end of the conversation, Muzamil asks Dr. Luqman the question he puts to most guests: how do you see Pakistan in 2050? Dr. Luqman has two young sons, aged seven and five, and he is honest about the anxiety that comes with watching them grow up in uncertain conditions. But his answer is not pessimistic.

He argues that Pakistan’s enormous population is also its potential. If you are genuinely good at something and find your niche, there is a real survival here. More than that, there is a satisfaction that comes from struggle that a comfortable system cannot replicate. He describes building his department from a point where basic instruments were not available to one that now handles complex procedures. “Looking back at it — شاید کسی بندے کو پتہ بھی نہ ہو کہ یہ جو department ہے آپ ایسا perform کر رہے ہیں کسی بندے کی محنت کی وجہ سے تھا۔” Names disappear. The work stays. That, he says, is how a legacy is built — incrementally, anonymously, one small input at a time.

Later in the discussion, Muzamil thanks Dr. Luqman not just for the surgery but for two specific qualities: the willingness to onboard the patient honestly through every risk and possibility, and the humility to recommend second and third opinions without treating those other views as a threat. “It’s a very rare quality and I would like to thank you for that.” Dr. Luqman’s response is characteristically understated: “You have to help me bring you to a position where I can do good work for you — and that’s what you did.”