Tears fell and questions arose when April Cloyd first heard the news: Her then 11-year-old son, Damien, had been diagnosed with a maxillofacial tumor.
Was it cancerous? How would it be removed? Would her son be OK?
Thankfully, a biopsy a few months later in December 2018 showed the lemon-shaped tumor was non-cancerous. But given its size, its location at the roof of Damien’s mouth, and the potential for it to lead to facial deformities — and also the potential of turning cancerous — his medical team advised surgery as soon as possible.
Given the complexity of the case, the team — led by plastic surgeon Haithem M. Elhadi Babiker, MD, DMD, and interventional radiologist John M. Racadio, MD — agreed there was only one place to perform the surgery: in our hybrid operating room.
“Dr. Babiker explained that a lot of places don’t have [a hybrid OR] and they were the only ones who could do it,” said April. “They caught it early and they got it all out.”
Imaging can be performed in the hybrid OR just before the surgery to help plan the procedure, as well as during the surgery to identify important anatomy or residual disease, and immediately after the surgery to evaluate results.
Benefits include less time in surgery, enhanced patient safety and improved surgical precision. There are advantages for both patients and surgeons.
“It takes away stress as a surgeon, and stress for the family,” said Dr. Babiker. “It’s time-saving and more accurate. It’s the use of technology to ensure better patient care.”
In terms of what an interventional radiologist does and what a surgeon does, Dr. Racadio says the lines are becoming more and more blurred. Cincinnati Children’s is on the forefront of improved collaboration between specialties.
“Rather than have a siloed relationship, we try to combine our skill sets to provide better care for the patient,” said Dr. Racadio. “We are trying to get to the point where surgeons and IRs are no longer speaking a different language.
"Surgeons don’t know everything that is possible with IR, so they don’t know what to ask for. Interventional radiologists don’t know details of surgeries, so they don’t know what to offer.”
Dr. Babiker agrees, noting that he uses the hybrid OR for select cases which might require the opportunity to do something else during surgery.
“It tells me how extensive the tumor is,” he said. “To be able to cut it out and look at what’s left behind to ensure it’s all gone and make sure the patient doesn’t have to come back.”
The design versatility of the Hybrid OR also allows different teams to perform multiple surgeries in one room, under one anesthetic, if needed, as opposed to performing a surgery one day, only to have more surgeries days or weeks down the road.
“Who would want to have their kid opened up a second time, if you didn’t have to?” asked April.
Following his successful surgery in February 2019, Damien, 12, said he is feeling much better now.
He’s back to playing favorite sports like football and basketball, as well as video games on his Xbox – as if nothing ever happened.
While in the hospital, he said there was “a bunch of stuff to do.” In particular, he enjoyed playing games online and TV trivia, adding, “And all the people were really nice.”
“They were wonderful,” April said about the staff and medical team – including the speech specialist who helped Damien swallow and begin eating following the surgery. “We couldn’t ask for anything better.”
Over the next several years, Damien will return to Cincinnati Children’s as needed for regular CT scans to ensure the tumor doesn’t return. When Damien is fully grown, doctors will remove bone from his shin and use it to build up the opening in his mouth. Then they will attach permanent teeth so he won’t have to take them out.
He remains pain-free, and thanks to a plastic mouthpiece that fills the roof of his mouth and replicates his lost teeth, most people can’t tell anything’s different about Damien.
“It makes it look like he’s had nothing done,” said April.
(Published December 2019)
Damien's diagnosis and surgery were difficult for the entire family, said April. But thankfully his dad, Anthony, was by their side the whole time. His older brother Sebastian visited Damien in the hospital as well, but now they're back to fighting and playing like normal brothers at their home in New Richmond, Ohio..
Intra-op 3D CT scan performed in the Hybrid OR at the beginning of surgery illustrates the extent of the tumor (highlighted in blue) in the roof of the right side of the mouth.
The 3D CT scan is displayed on a large in-room monitor in the Hybrid OR and can be rotated to any angle to help the surgeons better understand the location of the tumor during surgical removal.