A team led by a plastic surgeon put part of the boy's brain back in its place and rebuilt his skull and face.
By WES ALLISON
© St. Petersburg Times, published March 9, 2001
TAMPA -- Dr. Mutaz Habal had performed this operation many times before, but only once on a child whose condition was so advanced, and rarely was it so trying.
But after seven hours in surgery, John Esteban Martinez had a new skull, a new face and, the doctor hoped, new life ahead of him.
John, 7, was in stable condition Thursday night at Tampa Children's Hospital at St. Joseph's after what was described as a difficult but successful operation to put the left hemisphere of his brain back into place, rebuild his skull and reconstruct his face.
Habal, the plastic surgeon who led the operation, said the first 24 hours would be most critical, but he was pleased with the results. John's face always will be somewhat deformed, but his brain should now be protected by a skull against future damage.
"He looks like a human being," said Habal, still in his blue scrubs, a white face mask around his neck. "Give him a year or so. The bone will have to settle down in its new position and he will be okay."
John, of Medellin, Colombia, suffered from a rare birth defect called midfacial cleft syndrome. His skull did not form properly in the womb, leaving a fissure in the forehead. Over time, part of his brain squeezed through the silver-dollar sized hole in the front left quarter of his head, forcing his left eye out and down.
Because the brain was covered only by skin, an accident could have killed or severely injured him. And blood supply to that portion of the brain was limited, contributing to brain damage that has given John the mental capacity of a 3-year-old.
John will never regain the brain function he has lost, but the surgery should prevent future damage and, with proper therapy and hard work, allow him to develop more normally from now on.
"If you stimulate what is there, and we get off to a good start, then (kids) really take off," Habal said. He recalled two patients with similar conditions who went on to graduate from college.
John's parents, Luz Dary Zuluaga, 31, and John Jairo Martinez, 33, a security guard in Medellin, were taken to see their son right after the surgery. They declined to talk to reporters.
The day before, they had described him as a happy boy but one who was ostracized by other children because of his appearance.
A Miami congressman put the family in touch with Habal, who donated his services, as did Tampa Children's Hospital.
"This is what it's all about," said Rhonda Lemmo, one of two circulating nurses on the surgery team, who added she was surprised the operation went as smoothly as it did. "You work to be able to do something like this and help somebody."
The eight-member surgical team included Habal and Tampa neurosurgeon Dr. William Oliver DeWeese. The procedure ran long because of excessive bleeding from the skin covering the brain. The small fissure limited blood to the brain, so oversized blood vessels had developed in the skin to feed it. It was not an efficient detour.
"I don't know how he was alive, this kid," Habal said.
As soon as doctors removed the top of John's skull, the mass protruding from his face went limp as pressure was relieved.
The doctors then folded the covering of the brain a bit at a time, as one would pleat a skirt, squeezing out fluid as they went. By the time they finished, the left hemisphere was half its former size and would fit neatly into John's cranial cavity.
The top of John's skull had never fully developed, either, so the team needed to add a "second-story" to properly cover the brain, Habal said.
They used his own bone and artificial material designed to stimulate bone growth. If all goes well, his skull will be fully formed in a year and a half.
"We rebuilt the whole skull, just like you would build a house," Habal explained. "A young person has good capabilities to grow new bone."
Doctors moved his left eye toward the center and up, then shifted the nose. A photo taken just after the operation showed his face swollen and misshapen, but absent the massive lump that had dominated it before. Within six weeks, the doctor said, the swelling should be gone and he will look much better.
A reporter asked Habal to predict John's reaction to his new look. He shrugged.
"The self-image of a person is how he looks at himself," said Habal, who often operates on malformed children. "Sometimes we do even minor changes, and I don't see that much difference, but the child feels great. It can change attitudes and beliefs and feelings. It's really up to the person."
Surgery offers Colombian boy hope for normal life (March 8, 2001)