A medical first time in Canada - Surgeons at The Montreal Children's Hospital and McGill University successfully remove a tumour from a baby's face... through his scalp!



    
    (*) You can download photos and videos of the surgery including before
        and after photos of Jayden at
        http://www.thechildren.com/en/medias.aspx.
    

    MONTREAL, Sept. 1 /CNW Telbec/ - Surgeons at The Montreal Children's
Hospital of the McGill University Health Centre and McGill University 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's 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 McGill University and Université de Sherbrooke
and by Dr. Sherif Emil, Director of the Division of Pediatric General Surgery
at The Montreal Children's Hospital and Associate Professor of Surgery at
McGill University. 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's 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's brow would be perfectly smooth. The Montreal Children's Hospital
believes this is the first time an endoscopic procedure has been used in
Canada to remove a facial mass on a child's 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.
    "We were extremely surprised to learn the tumour was covered by bone,"
says Dr. Fanous. "Despite 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 'forest' of nerves, muscles and
vessels. The surgeon has to 'navigate' 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's upper face."

    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
'dermoid cyst'. 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's 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.
    "I 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," says Dr. Emil. "I 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."
    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's 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's
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.
    "We had complete confidence in both Drs. Emil and Fanous," says Ron
Cambridge, Jayden's dad. "We also appreciate the fact that Dr. Emil went to
all of the trouble to make sure my son wouldn't 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."
    "Jayden is an example of the unique care that can be provided by the
Montreal Children's Hospital and McGill University," says Dr. Emil. "Medical
and surgical experts from diverse disciplines can collaborate to provide the
best care for life."

    
    (*) You can download photos and videos of the surgery including before
        and after photos of Jayden at:
        http://www.thechildren.com/en/medias.aspx.
    




For further information:

For further information: Lisa Dutton, Manager Public Relations and
Communications, The Montreal Children's Hospital of the MUHC, (514) 412-4307

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The Montreal Children's Hospital

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