Facing the future

Liliana, or “Lilly” as she is often called, is happiest performing on the stage. The 13-year-old dreams of someday being a professional singer, but a couple years ago she wondered if that would be possible. 

Devastating diagnosis

Lilly’s mom, Antonia, noticed her cheek looked red and inflamed, but at the time it didn’t bother Lilly. The inflammation worsened, so Antonia took her to multiple dentists. She received different opinions but no concrete answers.

“No one could tell me for sure what was wrong with Liliana,” Antonia says. “Finally, we went to a place in Dallas where she had minor surgery and they found a growth in her cheek.”

Lilly underwent an initial CT scan and biopsy at a surgery center, and was referred to the Fogelson Plastic Surgery and Craniofacial Center at Children’s Health℠. Results from the tests revealed a benign but locally aggressive tumor, meaning it would continue to grow rapidly unless removed, but it would not spread elsewhere in the body.

James Seaward, M.D., a plastic surgeon at Children’s Health and assistant professor of pediatric plastic and craniofacial surgery at UT Southwestern, explained the extensive resection and reconstruction procedures to Lilly and Antonia. Risks include flap failure (death of the bone used in reconstruction), incomplete excision (not being able to get everything out), tumor recurrence, nerve injury, vision loss and bleeding.

“I was really scared because I had never been through surgery before,” Lilly says. “But Dr. Seaward was very nice and explained everything.”

Expert care

Two weeks later, Dr. Seaward performed the resection, which involved removing the right side of Lilly’s upper jawbone and the upper teeth to the lower half of the eye socket. For the reconstruction, Dr. Seaward and Jonathan Cheng, M.D., a plastic surgeon at Children’s Health and assistant professor of pediatric plastic surgery at UT Southwestern, took most of the fibula (one of the bones of the lower leg), together with its blood supply to keep it alive once it had been moved.

The bone was split into four pieces to reconstruct the different parts of the jawbone. The surgeons fused the bone parts together and to the other bones of the face using plates and screws. They then connected the blood supply to new blood vessels in Lilly’s face and reconstructed the eye socket with a titanium plate.

“Words can’t express how I felt in the waiting room,” Antonia says. “It was really hard for all of us.”

But “Super Lilly,” as she is known among staff members, made it through surgery well and began the month-long recovery in the hospital. She drank liquids during that time and then transitioned to soft foods and a regular diet. Lilly also needed help walking again.

To address all aspects of her recovery, Lilly’s multidisciplinary team includes a pediatric plastic and craniofacial surgeon, pediatric oral surgeon, pediatric dentist and orthodontist, pediatric psychologist, pediatric physical therapist, pediatric ophthalmologist and social worker.

“All of the staff at Children’s Health took great care of her through everything,” Antonia says. “They had good communication and always checked on her. Liliana feels good about her face.”

A thriving teenager

Lilly will need another surgery in the future to repair her teeth.

“She lost all her upper teeth on the right side so those will need reconstruction with implants once she has been tumor-free for long enough,” explains Dr. Seaward

In the meantime, Lilly is back to dancing and singing and, according to Dr. Seaward, she has a bright future ahead of her. “Liliana’s prognosis is good,” Dr. Seaward says. “She has been disease-free for nearly two years, so if this remains for another year, recurrence will be unlikely.”

Learn More

The Fogelson Plastic Surgery and Craniofacial Center at Children’s Health provides diagnosis and treatment for children of any age with any reconstructive need. Learn more about our programs and services.