Alegent Health Physician Cuts Door in Face to Save Woman

Doctor 'Cut Door in Face' to Save Woman

July 8, 2001

Article and Photographs reprinted with permission from the Omaha World-Herald.

Kelly Keown and son
The pink scar that stretches across Kelly Keown's eyebrows and down the right side of her nose is fading a little more each day.

But that scar played an important role in Keown's life: It marks where doctors essentially "cut a door in her face," peeled back skin and sawed through bone to remove a benign, but still dangerous, tumor growing in the middle of her head.

Doctors generally used to consider Keown's type of tumor inoperable. But a new specialized surgery - now being offered in the Midlands - allows doctors a chance to remove hard-toreach head tumors without disturbing vital nerves or disfiguring the patient.

Now, two months after her surgery, Keown said she generally is pleased with the outcome. The tumor is gone, and her face is healing.

"It took me 10 days before I could look in the mirror," said Keown, a 38-year-old mother of three. "But when I did, I was pleasantly surprised. I was prepared for the worst."

The tumor was discovered this spring after Keown started having unusual headaches.

One day, Keown's head started pounding after she bent over to pick up the newspaper. The headache lasted only a few minutes but was so intense that it forced her to sit down. The headaches became more frequent, and she started seeing spots.

Preliminary tests showed a mass growing in her sinuses, behind her eyes. Using the medical equivalent of a telescope, Dr. Thomas Dobleman, a head and neck cancer specialist at Bergan Mercy Medical Center in Omaha, did a biopsy of the golfball-size tumor.

The tumor, known as a schwannoma, grew from the cells that make up the protective sheath around the nerve fibers in Keown's sinuses. The tumor was uncommon, Dobleman said, and although it wasn't cancerous, it was dangerous.

"It was malignant by location," Dobleman said.

Already pushing into part of Keown's brain, the tumor was imposing on nerves and arteries in her head. Over time, the tumor probably would have killed her, Dobleman said.

In the past, even 10 years ago, many doctors would have advised against surgery because of the location. Instead, they may have tried to radiate the tumor and hoped it didn't grow back, he said.

But advances in technology and surgical techniques have led to the development of skull-base surgery, in which doctors dismantle part of the skull, remove the tumor and then put everything back together.

Dobleman has done several skull-base surgeries, including some that went through the face, like Keown's. He has been pleased with the success and has assembled a team of doctors and nurses to make future surgeries easier. He also is developing a head and neck cancer center at Bergan Mercy.

Several other doctors in Nebraska and Iowa do the surgery, including two who work for Nebraska Health System.

As in any surgery, there are risks. In this case, there is a chance that doctors could nick a vital nerve or artery. In addition, some newer types of radiation offer hope of destroying these types of tumors without surgery.

Keown said she was in shock when Dobleman started talking about doing surgery on her face to remove the tumor. She was concerned about how recovering from the surgery could affect taking care of her children, ages 2, 4 and 6, but she figured the doctors knew best.

"I didn't worry about the details. I let them handle that," Keown said. "Then I told my kids that mommy had a bump in her head that the doctors had to take out."

To do Keown's surgery, Dobleman first sketched out something that looked like a door on her face. The incision marks went from the right end of her right eyebrow to the left end of her left brow. Then he "cut a door in her face," she said, from the middle of her forehead down the right side of her nose.

Using special tools, Dobleman peeled back skin and muscle, moved an eye over and cut through bone to expose the tumor. Dobleman removed most of the tumor, then let neurosurgeon Douglas Long take out the part that had grown into her brain.

Then, six hours after Dobleman opened the door, he closed it.

First, the bones were secured using titanium plates and screws. Then, everything was allowed to go back in place and the tissue was sewn together.

In most cases, Dobleman said, a plastic surgeon also would have been on hand to reconstruct the patient's face. But, in addition to his training for skull-base surgery, Dobleman has studied plastic surgery and does most of his own reconstructive surgery.

"I feel like if you take something apart, you need to put it back together again."

Since the May 4 surgery, Keown's life slowly has returned to normal. But a few things still aren't the same. Because the tumor was on her olfactory nerve, which controls the sense of smell, Keown still has trouble smelling. And for some reason, her eyeglass prescription has changed.

In the end, Keown hopes that her surgery has a more wide-ranging effect outside her own health - letting people know that this procedure is being done in Omaha.

Keown said being able to have the surgery done close to home was an important factor in her recovery. Her children got to visit her in the hospital.

"If I'd had to go out of town for the surgery, it would have been like I just disappeared," Keown said. "That would have been tough."