Greenville News 11/27/2011, Page B01
Boy undergoes 47th jaw surgery
Last-minute hitch prompts change in operation plans
By Liv Osby
It wasn’t the surgery they’d planned, but Tyler Tucker underwent
another operation last week as part of the continuing efforts to
repair his damaged jaw.
It was the 47th surgery for the 11-year-old Greenville County boy.
Tyler underwent his first surgery as a toddler in 2002 after being
diagnosed with an aggressive cancer. Chemotherapy and radiation followed. The disease and treatments destroyed much of his jaw.
So once the cancer was in remission, doctors twice took bone from his legs to create a new jaw, but both attempts failed, leaving him in a lot of pain, as well as unable to speak or eat normally.
Then in August 2009, a titanium plate was implanted into Tyler’s remaining jaw bone to provide structural support, allowing him to eat and communicate better, and attend school.
But as he’s grown, his jaw has shifted, pushing the plate sideways so that it nearly broke through the skin near his ear, causing more pain, and more trouble speaking and eating, too.
“The plate was fixing to come through his skin … and something had to be done,” said his
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mom, Ashley Nance. “They couldn’t just leave him like that.”
To resolve the problem, doctors originally planned to take some bone from his mother’s leg to fashion him a new jaw, said Dr. Eduardo D. Rodriguez, a plastic and reconstructive surgeon and chief of plastic surgery at the University of Maryland Medical Center’s R. Adams Cowley Shock Trauma Center, where Tyler has been treated.
When she turned out not to be a match, though, Tyler’s father, Richie, was tested and found to be a match. So the plan was to take leg bone from him, Rodriguez said.
The operation, which was months in the planning, was scheduled. And the family made arrangements to travel to Maryland and stay at Ronald Mc-Donald House for two months.
But just days before the surgery, it was discovered that Tyler’s dad has a common virus — Epstein-Barre virus, or EBV — that could cause Tyler to develop lymphoma because he must take immunosuppressive drugs
after the surgery to prevent rejection of the donor bone, Rodriguez said.
Plan A was scrubbed.
“It was hard after all the planning. But in the end, it’s what’s best for Tyler,” Rodriguez said. “Patients who are going to be on immune suppression, and who are EBV-negative, have the potential of developing lymphoma. And the risk of him developing lymphoma was significant, especially with his past history of cancer. It would be horrible if he ended up developing lymphoma.”
But Tyler was suffering. Something had to be done.
So in a 12-hour operation Monday, Rodriguez’ team removed the old implant, which did push through the skin in the OR, he said. They then implanted another jaw bone fabricated of composite material and took a
flap of tissue from Tyler’s left thigh and transferred it to his right cheek to provide coverage over the implant. Rodriguez and his team have volunteered their services for all the surgeries while the hospital accepts Medicaid. Because of his condition, Tyler is uninsurable, Nance said.
Once he’s healed, he should be able to eat again, Rodriguez said, and have less pain. “We reconstructed a replica of what it would look like with the leg bone,” he said. “I think he’ll be comfortable for quite some time, better than before.”
It’s hoped that the bone transplant surgery can be performed in several months, he said.
Nance said Tyler came through the surgery well. He will be in the hospital about a week and at Ronald McDonald House after that.
“They lined him back up and filled in that side of his face. And they opened his ear back up and everything,” she said. “But he’s really swollen. No matter how many surgeries they have, you don’t get used to seeing them like that.”
Rodriguez said if everything goes well, the family should be able to return to Greenville by Dec. 2.
And while he’s missing Thanksgiving, at least now he’ll be home for Christmas.
“He’s so tough. He’s a great kid,” said Rodriguez. “The thing that pleases me the most is he’s growing, getting taller. Our future is bright.”
To follow Tyler’s progress, go to www.caringbridge. org/ visit/tylertucker
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