July 18, 2008

Guatemalan girl recovering after surgical journey

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In the photo at top, Joseline Vasquez Santay is comforted by her mother, Veronica Santay, following surgery to remove a large mass on the neck of the Guatemalan girl, shown below. (photos by Dana Johnson)

Guatemalan girl recovering after surgical journey

Guatemalan toddler Joseline Vasquez Santay arrived at the Monroe Carell Jr. Children's Hospital at Vanderbilt with a neck mass nearly the size of her head.

Joseline was first seen in November 2006 on a surgical mission trip to Guatemala performed by Children's Hospital doctors in partnership with the Shalom Foundation, a non-profit organization that provides medical care, education and nutrition to children living in poverty in Guatemala.

Joseline was just 6 months old at this time, and her mother, Veronica Santay, wanted to try more conservative treatments first, but when the team returned in December 2007, the mass had grown.

The mass was a lymphatic malformation. It was not cancer, but it did hinder Joseline's ability to breathe, eat and move her neck.

“Her quality of life is greatly impacted by this, and we knew it was something best addressed here in the U.S.” said Steven Goudy, M.D., assistant professor of Otolaryngology, who was on both trips to Guatemala and performed Joseline's surgery.

The surgery would require better equipment than what was available in Guatemala, so The Shalom Foundation paid for Joseline and her mother to travel here, accompanied by Maria Jose Arenales, director of programs in Guatemala for The Shalom Foundation.

Joseline arrived in Nashville June 27. An MRI showed that the mass was pushing her airway and two crucial blood vessels out of place. It also showed that the mass was made up of tiny balloons of fluid that would have to be removed individually.

The surgery began at 9 a.m. on July 8 and finished 14 hours later. The plan was for Goudy and his partner, Robert Sinard, M.D., to remove the neck portion first, and when he finished, Stephen Morrow, M.D., would remove the portion that extended into her chest. However, Goudy's part took much longer than expected, and the decision was made to leave the chest portion to prevent potential complications. Two-thirds of the mass was removed and the normal shape of Joseline's neck was restored.

“I feel good about what we did,” Goudy said. “The first rule in medicine is 'Do no harm,' and there were concerns that we would cause more harm than good if we continued the surgery. Because this isn't cancer, I didn't want to gamble with her well-being.

“It won't be like this never happened, but the cosmetic concerns are largely addressed and the functional concerns have improved hopefully. We still need to wait and see how she recovers.”

Two days after the surgery, Joseline was able to breathe on her own, and the following weekend she was moved out of the critical care unit and was out of bed playing with toys.

“It's going as well as we could have hoped,” said Goudy, “but there are still hurdles to cross, like infection, swallowing issues and movement issues. She's lived her whole life with this thing on her neck, so she might have a lot to relearn, like eating and head posture.”

Joseline may need another surgery in the future, but for now, her doctors want to let her heal and experience her childhood to the fullest.