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Saturday, December 17, 2005 - Page updated at 12:00 AM

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Haitian girl healing "according to plan" after facial surgery

Knight Ridder Newspapers

MIAMI — The plan had been to remove only part of the huge growth distending Marlie Casseus' upper face and leave the rest for future surgeries, but the operation went so well that doctors just kept going.

By the time they'd tied off the last of about 2,500 stitches minutes before midnight Wednesday, surgeons had opened the 14-year-old Haitian girl's face like a book and excised nine pounds of jellylike fibrous tissue, bone fragments, teeth and fluid.

With titanium mesh, they'd constructed a new framework for her facial features, which, lacking the support of the underlying growth, would have collapsed into an empty cavity.

They formed an upper lip, reduced the size of her overstretched mouth by 70 percent and — having been surprised to find her nasal septum intact — reopened her crushed nostrils with plastic "trumpets."

She lost 40 percent of her blood during surgery at the University of Miami/Jackson Memorial Medical Center's Holtz Children's Hospital, and received six units of replacement blood.

"She's healing according to plan," surgeon Dr. Jesus Gomez said Friday. "She's extremely happy and responsive," he said. "This morning, with my broken Creole, I told her to give me thumbs up, and she gave me one. She's a brave girl. ... From the surgical standpoint, we consider this a success."

Although she'll probably never be able to taste or smell, he said, Casseus will finally be able to see clearly.

Dr. Kami Parsa, a surgeon on the medical team, said pressure from the growth hadn't permanently damaged her left optic nerve.

"That's really exciting to see," he said, predicting that "her visual potential is going to be great. For the brain to see perfectly, the eyes have to be aligned," which the growth prevented.

Her brain then "shut off" information coming through the left eye.

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Casseus has McCune-Albright syndrome: a genetic condition that includes the uneven bone growth of polyostotic fibrous dysplasia and endocrine abnormalities.

The condition affects much of her bone structure and could return to her face, doctors cautioned.

She appeared to be growing normally for the first few years of her life, but by age 9, the mass had so distorted her face that she quit school.

By the time she came to Miami 10 weeks ago, she could barely breathe.

During Wednesday's surgery, doctors found teeth embedded in the mass near the inner corners of her eyes.

Casseus, who is in intensive care, will continue to breathe and be fed through tubes for about two months, when Gomez's team will remove the growth in her lower jaw.

He predicted two subsequent procedures, "to help her look a little more normal."

During the next procedure, doctors will remove the remaining growth, which weighs about seven pounds. They'll break and then reset Casseus' jaw using titanium plates, resuspend muscles in her tongue and on the floor of her mouth, and pare her lower lip.

The doctors unveiled an "after" photo, showing a dramatic difference from her pre-op profile. Where her face had ballooned outward in a heavy lump from below the eyes to the throat, it now lies flat down to the lower jaw, which remains distended.

Casseus' mother, Maleine Antoine, flanked by Gina and Ginette Eugene, the twin Haitian-American sisters who brought Casseus' plight to the attention of the University of Miami doctors, said in Creole that when she saw her daughter in recovery, she was stunned.

"I can't hide from you that I was in terrible shock. I'm looking at her and I remember my beautiful little girl and what she was before she got sick, then I remember that huge and monstrous mass that she was carrying, what I saw after the surgery was a lot of joy for me ... I know she will never be the same, but I'm so happy that the misery will end."

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