A new face, a new future

Children's Hospital Boston life-changing care, world-changing research (Dr. John Meara, Plastic Surgeon-in-chief) Well, I met him in March of this past year, and it was on a trip down to Haiti with Partner's in Health and Operation Smiles. During a medical mission to Haiti, John Meara, chief of Plastic Surgery at Children's, met 10-month-old Dumanel Luxama. It's a very difficult and arduous journey just to get there. It's in an area called the central plateau of Haiti. Very, very poor The infrastructure for healthcare is also almost nonexistent. There is a hospital there. We used that facility for that week. And midway back down the line I could see this poor little fellow here and obviously that was not something that could be managed and I knew there were potentially other inter-cranial issues that had to be dealt with. So,we thought it was best to try to get him up here to have a CT scan and have an evaluation with our neurosurgical team and with our team. So, it took several months, but with the help of Partners in Health actually, they helped with the visa issue and transportation and all that and they managed to get him up here. Day of surgery August 21, 2008 6:30 a.m. Good morning. Good Morning. Well, I could tell just by looking at him, even when we were in Haiti, that he had something called a frontal encephalocele. Which is actually quite rare. An encephalocele is actually a defect in the bone of the calvarium. So, the calvarium is the bone that protects your brain. And during development, what ends up happening is that part of the brain, and part of the covering of the brain actually protrudes through that defect. So, in Dumanel's case, he had a defect essentially between his eyes. So, he has a herniation of brain and the covering around the brain. that was coming through, essentially the top of his nose. The thing that we didn't know though was that Dumanel also had an arachnoid cyst. The combination of the two made the treatment somewhat more difficult. The complex surgery that removed the arachnoid cyst and the encephalocele took more than 8 hours. Dr. Smith and I were involved in removing certain portions of the calvarium so we could access the brain and the cyst. The next portion involved removing some of the bones over the eyes. That's called the fronto-orbital bandeau. So we removed that portion that was essentially on either side of the encephalocele. And then Dr. Smith removed the encephalocele, repaired the covering of the brain, and then the last portion of the procedure was really reassembling those pieces. Assembling the bones that are over the eye and assembling the frontal bones. Essentially repairing the defect in the skull. With the exception of a few small incisions, you might not even know. The amount of tissue that was removed from in-between his eyes is completely gone now. (one week after surgery) He has a few incisions on the lateral aspect of his nose and a little bit of edema or swelling, but after his hair grows in a little bit I don't think you'll really notice that anything was done. It was fantastically successful. In October, Dumanel returned to Coutan, his village in the central plateau of Haiti. In December, during another trip to Haiti, Dr. Meara visited Dumanel. Dumanel is expected to live a long and healthy life.