The surgeons of the hospital Sainte-Justine in Montreal should try today a delicate operation to restore his face to a girl of 8 years, the orbit of the right eye was devoured by a tumor.
Sagging of the eye, constant headaches and dizziness for more than three years : the surgical procedure of eight hours should allow the small Chanez Atmani return to a normal life, to the great relief of his parents.
In a first time, Dr. Alexander Weil, pediatric neurosurgeon at the Centre hospitalier universitaire Sainte-Justine and the Centre hospitalier de l’université de Montréal (CHUM), remove gently the tumor. The task will not be simple due to its proximity with the eye, the sinuses, the optic nerve and the brain.
And then his fellow plastic surgeons, Dr. Daniel Borsuk and Dr. Andrée-Anne Roy, will restore the face of the girl.
The important thing for them, they say, is to ensure at all costs that their small patient retains her beautiful energy and her smile.
“A profile photo, it is very powerful. The difficulty for me is that I want her to be happy, she is confident. It is very important to me. I know that the tumor will be removed without a problem, but I want that on my side, it is perfect also “, says Dr. Borsuk, chief of plastic surgery at Sainte-Justine.
This is why the doctors speak of restoration, a first in Quebec, rather than for a reconstruction that could leave more traces.
“We want it to be able to walk outside without the gaze of others, adds the surgeon. Just a nice girl without any concern over his appearance on social […]. It depends so much on our face. “
Too much pressure
Since the age of 5 years, the small Chanez Atmani lives with headaches and dizziness which kept her awake at night and prevents them from traveling, because of the too much pressure that causes the mass in his face.
“If the tumor is not removed, there are all sorts of risks for the patient,” says Dr Borsuk. There is a risk of crushing the brain. “
“She could lose functions in the eye,” adds Dr. Weil.
Described by his doctors as a little girl smiling, Chanez Atmani has suffered in January, a biopsy to ensure that the mass wasn’t cancerous. The doctors have taken the opportunity to remove a large piece, which has alleviated the headaches.
“Before the biopsy, it was every day,” recalls his mother, Idjouadiene Yasmina Atmani. She likes to go to amusement parks, [but] with his headaches, she could not do a lot of rides, because it made him turn his head. “
Postponed because of the COVID
The intervention was to take place on 24 April, but was postponed due to the pandemic. It is only last week that the family learned the good news.
“I am relieved, but also worried, that’s for sure. It’s going to be a heavy operation, it is at the level of the head and everything, but I trust the team. I know they have done worse things than this and have a good reputation in the field. It reassures me, ” added Mrs. Atmani.
To celebrate the removal of the tumour, the family plans to go to France next year to visit relatives.
“[Chanez] does not support travel by plane or by car, it’s going to relieve it for a lot of things. She wants to go to Disneyland. Without the mass, it will be more at ease, more free. She will be able to enjoy it, ” says the mom.
3D printing to make a first here
In a first step, the doctors will ask the guide acrylic on the skull of the young woman printed in 3D, to direct the cuts.
Surgeons have resorted to the technology of a printer in three dimensions to produce a prosthesis that is identical to the left eye socket of the young Chanez Atmani, so as to make the symmetry of his face.
This “restoration” of the orbit with the help of an implant is a first in Quebec, where we had rather a habit of ” reconstructions “, that is to say, of operations designed to recreate the form and function, without necessarily rediscover the aesthetic from before.
Normally, during a rebuild, the doctors collect the bones of the skull of the patient, trying to reproduce as faithfully as possible, the other side of the face, even if it is impossible to draw a perfect symmetry, ” says Dr. Daniel Borsuk, a plastic surgeon.
“In this case, one wants to restore. We want it to return as it did before the tumor, and that is the difference, he adds. With computers, you are able to create an exact shape, which corresponds to the mirror image of the other eye. “
Painstakingly, the doctors will cut and gratteront inside, in order to remove the tumor.
A piece of the puzzle
Thanks to a scan of the face of the little girl, the surgeons were able to 3D print a reliable reproduction at 0.4 mm from the skull of their young patient, as well as a prosthetic device in a polyetheretherketone (a thermoplastic) and a “guide” in acrylic, which will be used during the operation to direct the cuts.
These “puzzle pieces” that fit together, one inside the other allowed them to analyze the steps of the intervention, ” explains Dr. Borsuk.
“A picture is worth 1000 words, but a statue is worth a million. It has helped us to reflect on the best way [to address] this tumor there, just looking at the 3D model of the skull, ” he adds.
Finally, the implant will be placed over the skull of the little girl with the help of three small plates in titanium.
Avoid the bleeding
When the small Chanez Atmani will be under anesthesia, the team will work to saw the bone of the orbit (using the guide), before to cut, scrape and remove the mass.
“Dr. Alexander Weil is going to go very gently, very gently, probably with a microscope to ensure that it does not create a hemorrhage,” described Dr. Borsuk.
And then, once the tumor is removed, surgeons will implant with the aid of three small plates in titanium – very thin, but also very resistant – before reassembling the whole.
“It’s just that !” concluded in the interview, Dr. Borsuk, smiling.