About Face – Craniofacial Services
December 22, 2008
Bryttany has faced many challenges in her 14 years but none as overwhelming as an eight hour surgery in August 2007 to give her a new face. Bryttany was born with an extremely rare form of bony overgrowth syndrome that left her face and skull disfigured.
Tamiko, Bryttany’s mom, said Bryttany was about one month old when they noticed the right side of her face was growing rapidly. Also, a large birth mark appeared in the same area. Doctors did not know how to handle her situation. The family moved to San Diego in 1998 and Bryttany’s family consulted with plastic surgeon Dr. Steven Cohen of Rady Children’s Hospital’s Craniofacial Services.
“We did a first stage surgery on her skull in 1999 when she was about 5-years-old,” said Cohen. “We had to address that first before we could deal with her other problems. Usual cranial thickness is ½ inch or less during childhood and her skull was a foot thick. We carved it down and reshaped the skull to give her a more normal appearance.”
Because she was still growing, Cohen monitored her over the years, but her condition worsened considerably.
“She developed recurrent disease over her right eye and right forehead and began to develop signs of severe abnormality in her lower jaw, which became extremely protrusive,” Cohen said. “By 2007, we knew it was time to perform a major reconstructive surgery to prevent orbital growth from growing into her orbital cavity and affecting her vision.”
Because of her appearance, Bryttany became more and more withdrawn. She did not want to go out or talk to people. Her mother found a counselor to help her cope with the teasing, staring and pointing from others.
Tamiko knew the surgery would be long and dangerous, but she also knew this was important to Bryttany and it would give her a chance for a normal life.
“My husband and I were so worried because of the length of the surgery and the complexity of the procedure,” said Tamiko. “When Dr. Cohen told us what they were planning to do, we both cringed.”
Tamiko said the ordeal has been very tough for the whole family. It is very challenging to have all the doctors’ appointments, surgeries, hospital stays as well as intense emotional stress. Bryttany has three brothers – Bryson, 18, Darius, 9, Jonathan, 2, and a sister, Timira, who lives in Ohio.
A team of specialists from Craniofacial Services that included neurosurgeon Hal Meltzer and craniofacial services Fresh Start Surgical Gifts fellow Dr. Landon Pryor in addition to Cohen began the lengthy surgery in August 2007.
Cohen said Bryttany presented a unique challenge because they were treating an unknown condition in a growing child and they needed to intervene to prevent more extensive growth and deformity. The surgery took nearly eight hours during which the team of neurosurgeons worked with craniofacial plastic surgeons to remove the excess bone of her skull and around her eyes, reposition her midface and teeth and set back her protrusive lower jaw. They also shortened her tongue to fit her new jaw.
“Without a top notch operating team of technicians, nurses and anesthesiologists and without a world-class intensive care unit that was able to handle Bryttany’s challenging aftercare, we would not be able to take care of patients like Bryttany who come to us from throughout the region and the United States,” said Cohen.
“Having been involved in such a complicated reconstruction and being able to see how this transformation has given Bryttany a fresh start in life has really been a very unique and rewarding experience,” said Pryor.
The recovery period was particularly difficult and hard on the family.
“She was in the ICU for ten days on life support,” said Tamiko. “They had to give her so much sedation because of the pain that they had to use a respirator to breathe for her.”
Cohen said he has never seen a condition like Bryttany’s before in his practice and they sent samples of her bone to pathology experts around the country but nobody could come up with a firm diagnosis. He doesn’t know why it occurred or what the long term prospect is for Bryttany, but he thinks it will be good. He said that she will need follow-up surgery to the jaw and soft tissue lesions on her right cheek and a refinement of her nose.
Tamiko said the surgery has made a huge difference for Bryttany and turned her life around.
“Before, people would stare at her,” she said. “Now they still look but think she just has a birth mark. She started a new school this year and she’s just one of the girls – it has made a world of difference. She has done really well at school – she has won awards for statesmanship and was on the honor role.”
“I graduated from Ray Kroc Middle school in June, and I was excited my dad came from Ohio to see me graduate,” said Bryttany. “I’m going to stay with him in Ohio this summer and then start high school here in the fall.”
Originally published in Kids’ NewsDay, San Diego Union-Tribune,
October 7, 2008.