Local Doctors Work Together To Reconstruct Child’s Tongue After Cancer


UPDATED: Thursday December 19, 2013 6:54 PM

Medicine has been called an art as much as a science.  Some medical artists from Nationwide Children's Hospital teamed with colleagues from the Ohio State University James Cancer Hospital to save a child's life - and give him a chance to tell about it.

Brady Sanford is an active and exuberant five-year-old.  As he joined his parents in a game of Monopoly Junior, he pulled out a Chance Card and read the instructions in a clear voice, full of expression.

"Go to any brown party space.  If no one owns it, get it for free!" he crowed with a big grin.

It was an everyday feat that Jamie and Daniel Sanford once feared would be impossible.

Last year, when Daniel was brushing his son's teeth, he noticed blood, and called the doctor.  The pediatrician discovered a lump the size of a pea on the underside of Brady's tongue. Within two days, it had grown to the size of a lima bean.

Brady wound up at Nationwide Children's Hospital.  Doctors did a biopsy immediately.

"They came out and said, 'We think that it is cancer'," Jamie said.

"Shock was the first thing that came to mind," Daniel added.

They were especially shocked because they are both microbiologists and have studied cancer.

"I'm a professor so I teach it, and my husband researched it in graduate school. And it was just nothing that we thought you'd ever be dealing with necessarily first-hand with your four-year-old.  Children don't have cancer of the tongue. It's not something they see, " Jamie said.  

It stunned doctors, too, because Brady had a rare type that usually appears in the joints of adults.

Dr. Charles Elmaraghy, an otolaryngologist at Nationwide Children's Hospital, said, " We actually had to go through literature to try and find a case that was similar to Brady's, and we actually didn't find much that was similar. "

He said that only 13 cases involved this type of cancer in the tongue, and all of those cases were in adults.

He talked with his team at Nationwide Children's Hospital as well as a team from the OSU James Cancer Hospital that included Dr. Matthew Old and Dr. Theodoros Teknos. They planned how to remove the tumor and replace the sections of Brady's tongue that he would lose in the surgery.  The procedure has worked in some adults.  Brady was just four years old, but they thought it was his best chance.

"The anatomy's thoroughly similar.  It just that there hasn't been a precedent for doing it in that age group," Dr. Elmaraghy explained.

The doctors worried about how it would affect Brady's life.

"We felt like he was going to be limited with regard to his ability for speech, and even specifically for swallowing," Dr. Elmaraghy said.

"We had to explain to him that he was going to have a new tongue, and he might not be able to talk," Jamie said.

In a ten hour surgery, the medical teams removed about a third of Brady's tongue, then reconstructed a new one out of skin from his forearm.  They carefully connected tiny blood vessels.

"You have to find donor vessels in that region and actually recipient vessels in the neck, to connect that tissue to. In a pediatric patient, sometimes you're concerned about the size of those vessels, whether they'll be able to sustain that tissue to allow it to have adequate blood flow for it to survive," the doctor explained.

His mother said that the medical team kept Brady sedated after surgery, and only slowly brought him awake over a week. The week after that, Brady looked at Dr. Elmaraghy and counted to three.

The doctor was shocked.

"I actually look a video with my phone because I couldn't believe it," he said. He then texted the video to his colleagues.

But more treatment lay ahead for Brady.

"He got a combination of two different chemo agents over the course of six different treatments," Daniel said.

Brady's tongue has two distinct colors now.  Two-thirds is pink.  One-third is cream-colored.  He gets quarterly check-ups and medical scans to monitor his progress.

Now Brady talks like a champ.  He started kindergarten at Evening Street School in Worthington last fall.  At Show and Tell - he shared his tongue.

Dr. Elmaraghy shook his head and smiled.

"The ability for children to heal and to adapt is remarkable, and Brady certainly demonstrated that,"  he said.

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