THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Tuesday, May 9, 1995 TAG: 9505090252
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: By DIANE TENNANT, STAFF WRITER
DATELINE: NORFOLK LENGTH: Long : 153 lines
For 15 years, seeing was believing for Agustina Disuma.
The herniated brain tissue that protruded from a nickel-sized hole in her forehead had caused the Filipino girl to quit school in sixth grade and become a virtual recluse, imprisoned by the baseball-size deformity she could see reflected in her mirror.
But on Monday, before an international audience of doctors, a team from Operation Smile gave ``Tina'' something else to believe in - miracles.
At 8:34 a.m., neurosurgeon Jerry Penix stood in an operating room at Children's Hospital of The King's Daughters and marked his cutting line across Tina's shaved head.
``Any time you're ready,'' he said to scrub nurse Joan Austin.
``OK,'' she replied, and the soft hiss of the suction tube began picking up the drops from the incision.
The eight-hour operation married the talents of Penix, who removed the hernia - called an encephalocele - and plastic surgeons Dr. William Magee and Dr. Richard Lewandowski, who remade Tina's face with bone grafts and tiny curved needles.
It also educated an international audience of 35 doctors who were visiting as part of Operation Smile's physician training program. They watched the procedure on television monitors in a nearby conference room.
``If she were born in the States, this would have been taken care of when she was maybe 3 months old,'' said Magee, the founder of the charitable medical organization Operation Smile. But Tina was born to a poor family on the far side of the world, and the hernia on her forehead grew larger and larger for 15 years before an Operation Smile screening team met her and arranged for her to come to Norfolk for the free surgery.
Dr. Penix has elevated the biocranial flap,'' Lewandowski, a medical fellow from Australia, told the TV audience. ``You'll see the root of the encephalocele shortly, as we come down here.''
Penix laid Tina's scalp down over her face and picked up a tiny hammer. The tapping sounded over the beeps of the heart monitor.
``That's the base of the defect that you're seeing,'' Lewandowski reported. ``It's about the size of a nickel, perhaps a little larger than a dime, which won't make much sense to those people from outside the United States. We're gonna move now to the frontal bone.''
Penix, his eyeglasses taped to his surgical hat, leaned forward and picked up a drill.
In the waiting room outside, Gloria Linaac waited anxiously. Tina's escort from the Philippines, Linaac had introduced her charge to white Britannia athletic shoes, pink stuffed rabbits and Norfolk's Waterside. Tina's parents had signed their daughter into her care for the trip to America, and Linaac, by her facial expression, certainly cared.
In the operating room, sterile masks obscured expression. ``One, two, three, four . . .'' Austin counted tiny sponges so none would be lost in the incision. At 9:17 a.m., the electric drill bored into Tina's skull.
``They have to cool it a bit or it will burn the bone,'' Lewandowski told his audience, as water ran past the drill bit. ``As you can see, Dr. Penix has drilled five holes. Then he'll join them up and remove that frontal bone.''
Tina's forehead went into a bowl on the table, and Penix began suturing the stem of the cyst that hung, mushroom-shaped, from her brain.
``You should be able to see the stalk. . . ''
``One, two, three, four. . . ''
Beep.
``Is that my beeper?'' Penix asked. Nurse Susan Roberts checked the pager, wrote a phone number on the knee of her scrub suit, and dialed the phone. ``Are you paging Dr. Penix?''
``It's difficult to see this, but he's going to cut a V-shape out of the frontal bone. . . ''
``Helloooo. This is Susan Roberts, returning a call for Dr. Penix. He's in surgery.''
``One, two, three, four. . . ''
Lewandowski glanced around the room, and his eyes landed on three foreign doctors who had just come in. ``Do we have somebody who could take a photograph for us?'' he asked. ``It's all auto-focus. Just step in and press the button.''
The flash went off twice, and the telephone on the wall rang.
``Well, he's in surgery,'' Roberts said into the receiver. ``Can I take a message?''
A soft sizzle competed with the hiss of suction. ``He's cauterizing the area so he can get a better idea of where he can amputate it,'' Lewandowski explained. ``It's just like a hernia anywhere else. You have to get around the base of it before you can repair it.
``Anything that protrudes is probably not gonna be of value and is better off amputated. It's very fibrous, not like neural matter. It's not like squashy Jell-O, it's more like squashing a rubber ball.''
Operation Smile sends approximately one volunteer team a month to screen children for free head and facial surgery, reaching into 13 countries as well as the United States. Next week, Tina will visit New York to participate in an Operation Smile fund-raiser with Bianca Jagger and John Kennedy Jr. aboard the Intrepid, an aircraft carrier that has been converted into a museum.
In February, during a visit to the Philippines, doctors performed 850 operations in five days. Tina's case was too serious to be done at home, so she was flown to Norfolk.
Penix finished amputating the hernia at 11:03 a.m.; then the plastic surgeons stepped in. They would remove sections of bone from Tina's skull so they could build her a new nasal bone and patch the hole in her forehead where the encephalocele had protruded. But first, they laid the skin of her face back in place.
For the first time in her life, Tina was seen without the hernia.
``She's gonna look great,'' Magee said. ``It's just amazing, when you think that in six hours, this kid's whole life is gonna change. For 15 years she had absolutely no chance of a normal life. Here, in about six hours, she'll go from a recluse to a normal life.'' He bent to his work. The hours passed.
``OK, we're gonna put the frontal bone back on,'' Lewandowski told his audience. He began setting screws in the bone. Next would come filling holes in the skull with bone dust made by the drill, suturing the scalp back on, finishing the nose. Three visiting doctors craned their necks to see. Magee eased past them on his way to another operating room, and another child.
``Look at this little kid,'' he said. ``She's gonna look great.''
``She's gonna be a happy girl, isn't she?'' asked a nurse.
``Any questions?'' Lewandowski asked his audience.
``If you're looking for a way to create an image for America, what better way to do it than through the face of this beautiful little girl? When people help one another,'' Magee said, ``miracles happen.'' ILLUSTRATION: B\W
X-Rays
The large circle on Agustina Disuma's face shown in the left CT scan
covered her nose - and was so traumatic for the Philippine native
that she withdrew into the life of a recluse. But on Monday, in an
eight-hour operation at Children's Hospital of The King's Daughters,
the herniated brain tissue - an encephalocele - was removed. A
neurosurgeon excised the bulbous tissue that protruded through a
nickel-sized hole in Tina's skull, and plastic surgeons rebuilt that
area of her face.
Color staff photo JOSEPH JOHN KOTLOWSKI
Agustina Disuma [on the operating table]
Photo
The operation put a smile on the face of Tina's escort, Gloria
Linaac, center, as she talks with Eva Jana - with whom Tina is
staying.
KEYWORDS: OPERATION SMILE by CNB