Saving apperance, and quality of life
For 32-year-old ilana laitman, the saga began five years ago with a stubbornly impacted wisdom tooth. When her oral surgeon in Israel took X-rays, the films returned with a shocking surprise: a giant bony tumor embedded in the right side of the young patient’s jaw. Eventually, further tests diagnosed it as ameloblastoma, a benign but aggressive tumor arising from cells that form tooth enamel during development.
Laitman immediately embarked on a journey that brought her to every major hospital in Israel for opinions from the country’s top maxillofacial surgeons. As a self-employed lawyer and part-time political activist, Laitman’s appearance and ability to speak clearly were extremely important to her. But with every visit to a new physician, she received the same devastating news: The planned procedure, which would replace a significant portion of her jaw with cadaver bone held in place with a metal tray, would cause significant disfigurement.
“I received the impression that I would be crippled,” she says. “A normal face, normal speech, normal smile and normal boyfriend would be out of reach. Quality of life just wasn’t something my doctors were concerned with.”
Hoping to find other options, Laitman turned to other patients with this rare condition, which doctors diagnose in fewer than one out of every 500,000 people worldwide every year. Finding others with her condition on Internet community boards, she requested photos of those patients after surgery, then reached out to doctors of those whose appearances still looked healthy and normal. Eventually, Laitman’s search led her to Wayne Koch, who directs Hopkins’ Head and Neck Cancer Center.
Though Laitman’s tumor wasn’t malignant, it would require an aggressive approach that matched the disease’s nature. Koch remembers his first meeting with Laitman in early April 2009, after Johns Hopkins International facilitated her travel to Baltimore, as an intense one. Laying out the plan, Koch explained that Laitman would lose the majority of the right side of her jaw to completely remove the tumor.
“My role is to get all the tumor out so that it never comes back,” he says. “That meant I needed to be ruthless in saying that we couldn’t cut corners for cosmetic benefits.”
But it didn’t mean that preserving Laitman’s quality of life wasn’t important as well. In the consultation with Koch, then during a second consultation immediately afterward with facial plastic surgeon Patrick Byrne, the physicians assured Laitman that saving her appearance and functionality was a high priority. After removing the portion of her jaw that contained the tumor, Byrne’s team would replace it with a section of shin bone, or fibula.
“Replacing her jaw with fibula was more reliable,” Byrne says. “Since her bone comes with its own vessels, we can connect them to the blood supply in her neck so the transferred bone stays stable.”
On the morning of April 7, 2009, the two surgeons and their teams commenced Laitman’s procedure. As Koch’s team removed the tumor and isolated the blood vessels in Laitman’s neck, Byrne’s team removed a section of fibula, precisely shaping the bone into the patient’s new jaw. The bulk of the 14-hour procedure concentrated on reconstruction, rebuilding Laitman’s appearance to closely match her presurgical one.
After the operation, both physicians visited Laitman frequently throughout her two-week hospital stay and additional month and a half in Baltimore as she relearned to talk and eat with her new jaw and walk on her affected leg with the help of Hopkins’ rehab team. Today, three years later, Laitman says the only physical evidence of her surgery is a small scar on her neck and an additional one on her left leg. She’s successful in her career and back to an active lifestyle, which includes swimming, running and martial arts.
“If the operation had been a ‘success’ but I’d lost my quality of life,” she says, “it would almost have been like death. Now that I’ve had this experience, I know that nothing is impossible. All the obstacles in my life now look very small.”