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Surgeons at The Montreal Children鈥檚 Hospital and 捆绑SM社区 University successfully remove a tumour from a baby鈥檚 face..鈥� through his scalp!

Surgeons at The Montreal Children鈥檚 Hospital of the 捆绑SM社区 University Health Centre and 捆绑SM社区 used a novel approach for the first time in Canada to remove a tumour embedded in the upper face of Jayden Cambridge, an 18-month old child. Using a new endoscopic technique, the surgeons entered from the toddler鈥檚 scalp, above his hairline, to retrieve the tumour located in the middle of his forehead. Thanks to this new procedure, the little boy will be spared an unsightly scar, and instead has a tiny one hidden by his hair.

This ground breaking surgery, which took place on August 27, 2009, was performed by Dr. Nabil Fanous, Associate Professor of Facial Plastic Surgery and Head and Neck Surgery at 捆绑SM社区 and Universit茅 de Sherbrooke and by Dr. Sherif Emil, Director of the Division of Pediatric General Surgery at The Montreal Children鈥檚 Hospital and Associate Professor of Surgery at 捆绑SM社区. The surgery proved more complicated than anticipated. After the endoscope and attached camera were introduced inside the upper face, the tumour was nowhere to be found! To locate it, the lead surgeon Dr. Fanous had to probe the forehead using special instruments. As it turned out, the tumour was hidden under a bony shell that had grown over it. The shell was thin in the middle, much like an egg, but thicker on the sides. Dr. Fanous had to delicately pierce the shell to excise the tumour, and then pull it out via the tunnel leading to the child鈥檚 scalp.

The tumour was the size of a large blueberry (it measured about one by one centimeter) and was sitting in a deep bony crater that looked on the computer screen a bit like a small volcano. Dr. Fanous smoothed down the contours of the crater and filled the indentation with bone wax to make sure Jayden鈥檚 brow would be perfectly smooth. The Montreal Children鈥檚 Hospital believes this is the first time an endoscopic procedure has been used in Canada to remove a facial mass on a child鈥檚 face through a tiny scalp incision. As well, this is the first reported case of such a tumour being covered by bone.

The child was discharged about an hour after surgery. He has recovered rapidly and fully since.

鈥淲e were extremely surprised to learn the tumour was covered by bone,鈥� says Dr. Fanous. 鈥淒espite this hurdle, the surgery went extremely well. This type of surgery requires a relatively simple technique, but the surgeon has to be careful because the face contains a dense 鈥榝orest鈥� of nerves, muscles and vessels. The surgeon has to 鈥榥avigate鈥� around all of these elements to get from point A to point B. If the surgeon inadvertently damages one of the important nerves or muscles, he risks permanently affecting or even paralyzing the child鈥檚 upper face.鈥�

HOW IT ALL BEGAN

Dr. Sherif Emil was the first surgeon to examine Jayden in late 2008. He determined the toddler had a congenital tumour, possibly of the type called 鈥榙ermoid cyst鈥�. While this type of tumour is benign, it has to be removed because it may grow as the child ages and could rupture, causing serious infection and scarring. Traditionally, these types of tumours are removed by simply cutting through the skin and muscle directly over the tumour. However, this technique leaves a scar, one that Dr. Emil wanted to avoid at all costs since it would be in the centre of Jayden鈥檚 forehead. Also, the scar would have gotten larger as Jayden got older, especially since the little boy has dark skin. People with dark skin are known to have much higher risk of scarring. Thanks to the use of this new endoscopic technique, Jayden will be spared an unsightly scar. Instead, he has a tiny scar hidden by his hair.

鈥淚 had read about the endoscopic excision of benign forehead masses in the Journal of Pediatric Surgery. Pediatric surgeons at Stanford University had used the technique,鈥� says Dr. Emil. 鈥淚 knew right away Jayden was a perfect candidate for this procedure. I wanted to do everything possible to prevent the child from having a scar in the middle of his forehead.鈥�

Because this technique had never been used in Canada to remove a facial mass, Dr. Emil began to search for a surgeon with enough experience to attempt it. He finally reached Dr. Fanous, a renowned facial plastic surgeon. While Dr. Fanous had never performed this surgery on a child, he had done it hundreds of times on adults during facelift surgery. He readily agreed to perform the surgery and to provide the necessary equipment to The Montreal Children鈥檚 Hospital.

It took eight months from the first time Jayden was seen by Dr. Emil until the day of his surgery. During the surgery, the anesthesia team headed by Dr. Pierre Fiset, Director of Pediatric Anesthesia, secured the child鈥檚 safety. A number of surgeons and surgical trainees filled the operating room in order to witness this ground-breaking procedure. The nursing staff prepared tirelessly for the operation, assuring a calm and safe environment for the patient.

鈥淲e had complete confidence in both Drs. Emil and Fanous,鈥� says Ron Cambridge, Jayden鈥檚 dad. 鈥淲e also appreciate the fact that Dr. Emil went to all of the trouble to make sure my son wouldn鈥檛 have to live with an ugly scar on his face. I really feel he went the extra distance and, for this, my wife and I are very grateful.鈥�

鈥淛ayden is an example of the unique care that can be provided by the Montreal Children鈥檚 Hospital and 捆绑SM社区,鈥� says Dr. Emil. 鈥淢edical and surgical experts from diverse disciplines can collaborate to provide the best care for life.鈥�

For more information please contact:
Lisa Dutton
Manager Public Relations and Communications
The Montreal Children鈥檚 Hospital of the MUHC
514-412-4307


***You can download photos and videos of the surgery including before and after photos of Jayden at: