Surgeon helps African boy with lymphatic malformation

The road traveled has been long for two-year-old Prince Phakati and his mom.

They’re from South Africa, but at two-and-a-half years old, Prince and his mother began a journey that would change his life. Their search for help led them to New York and Pediatric Facial Plastic Surgeon Milton Waner. Ironically, Waner grew up just 10 miles from where Prince now lives in Africa.

"He speaks Zulu,” Waner said, “and when I was raised, it was pretty much the first language I spoke."

Doctor Waner met Prince for the first time when he came to the US for facial surgery. Prince suffers from something called lymphatic malformation.

"These are the vessels that pick up all the extra fluid in the body. I guess you could say they are the gutter system of the body,” Waner explained.

The vessels collect excess fluid and put it back into the veins. But Prince has an abnormality of the vessels. The fluid backs up because the vessels cannot transport it efficiently.

Prince was born with the problem. The older he gets, the larger the malformation will grow on his face, and his mother, Martha didn't want to see that happen.

"See if my son can look better and look like a normal baby," she said.

In a four-hour operation, Doctor Waner removed the abnormal vessels, sparing the main nerve that allows facial movement.

"My intention is get him to look completely normal,” said Waner.

It took two surgeries to do that. And now, a little boy on his way to being completely healed.

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MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: SAVING FACE: A TODDLER'S SURGICAL JOURNEY
REPORT: MB #3347

BACKGROUND: Lymphatic malformations are sponge-like collections of abnormal channels and spaces that contain clear fluid. The lymphatic system normally collects excess fluid from the tissues and transports it through a series of vessels back into the venous system. However, with a lymphatic malformation, transfer of the fluid through the vessels is slowed. The excess fluid accumulates and dilates the vessels, which results in swelling of the affected area and sometimes enlargement of soft tissues and bones. These lesions are most commonly found on the neck and armpit, but they can involve any area of the body. The lesions steadily increase in size, but some enlarge more quickly than others. The exact cause of lymphatic malformations is not known, but some believe they are caused by errors in the formation and development of blood vessels during fetal development.
(SOURCE: Cincinnati Children's Hospital)

TYPES OF LYMPHATIC MALFORMATIONS: There are two types of lymphatic malformations: macrocystic malformations and microcystic malformations. These are often combined. Macrocystic malformations are large, soft, and smooth clear masses under normal or bluish skin. Microcystic malformations present as small, raised lesions containing clear fluid. Both types may cause enlargement of any structure. Lymphatic malformations in the skin may show up as tiny clear bubbles, called vesicles, that sometimes become dark red due to bleeding. Gorham syndrome is a type of lymphatic malformation that involves the bone and surrounding soft tissues.
(SOURCE: Cincinnati Children's Hospital)

TREATMENT: Some lesions, especially those that are localized, are treated by surgical removal. Sclerotherapy with alcohol, doxycycline or other drugs may be used to shrink the lesions. Laser therapy may also offer benefits for some types of lymphatic malformations. Radiofrequency ablation and chemotherapy agents may also be used in some cases.
(SOURCE: Cincinnati Children's Hospital)

ONE DOCTOR'S STORY: Milton Waner, M.D., BCh, FCS (SA), is a pediatric facial plastic surgeon and is the director of the Vascular Birthmarks Institute of New York, St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center. Dr. Waner grew up in South Africa and recently treated a toddler who traveled from the same area. The patient -- two-year-old Prince Phakati -- was born with a lymphatic malformation. In a four-hour operation, Dr. Waner removed the abnormal vessels -- sparing the main nerve that allows facial movement. Dr. Waner says Prince will need more procedures in the future, and his staff will remain in communication with the family to determine when he needs to come back. (SOURCE: Dr. Milton Waner)

FOR MORE INFORMATION, PLEASE CONTACT:
Jeff Jacomowitz
Associate Director of Public Affairs
St. Luke's-Roosevelt Hospital
JJacomo@chpnet.org

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