New York City surgeon restores disfigured teen’s nose in breakthrough transplant
A terrible accident when he was 9 left Dallen Jennet disfigured and missing his nose.
The Marshall Islands boy resigned himself to a life alone, a life of staying out of sight so nobody would stare at him.
He stopped going to school after his accident and spent five years in self-imposed isolation — until a lucky break brought the teen Dr. Tal Dagan. The associate adjunct surgeon at New York Eye and Ear Infirmary of Mount Sinai, stumbled upon Jennet’s case during a August 2014 Marshall Islands trip organized by Canvasback Missions.
“When I was there, I heard about Dallen, and the organizers asked me if I wanted to take a look to see if could help him,” said Dagan, 44. “I said, ‘Sure.’ ”
He had no idea how challenging it was going to be.
The first hurdle was getting to Dallen. The boy, then 14, lived in a remote location with his family and didn’t like visitors. It took go-betweens and diplomacy to get Dagan out to Dallen’s house — and then he had to get the teen to look at him.
“He was depressed, just sitting there on a rock and staring at the ground,” said Dagan. “He didn’t want to look up at me.”
Dagan coaxed Dallen into lifting his head, the doctor was stunned. The boy had a hole for a nose and a deep depression on his face where the skin and tissue had burned away. A nasty scar ran cheek to cheek.
“It was a terrible, psychological detriment to this kid,” Dagan said.
The injuries had occurred five years earlier, when Dallen — with some friends — was climbing a coconut tree that grew alongside a neighboring house. When he scaled the slender tree and moved onto the roof, he stepped onto a high-voltage power line, Dagan said.
“It evaporated his nose, just completely burned it away,” the doctor said.
It also zapped the tissue across his face — leaving him with a visible concavity — cataracts in his eyes and a depression in his skull. The accident also cost him several toes.
Although two other surgeons had come to look at Dallen before Dagan, the consensus was there was nothing to be done for him.
The absence of any cartilage — or any living tissue — made it next-to-impossible to create a new nose.
But Dagan couldn’t stand the thought of leaving the youngster in pain and isolation.
“I said, ‘If you can get him to New York, I’ll do it,'” the doctor said.
By the time Dallen arrived in New York this past June — to stay at the Ronald McDonald house — the surgeon had worked out a plan for what he called a “3-D nose transplant,” the first of its kind in the U.S.
Using a new type of 3-D printing material, Dagan studied pictures of Dallen’s siblings. He hoped to create the most natural-looking nose possible for him.
When he finished, the doctor had a model that could be broken apart, like a jigsaw puzzle that snapped together.
Dallen underwent a grueling 18-hour procedure that included removing most of his face. Dagan also used a cutting-edge laser that injected green dye into the boy’s blood.
“We could follow it to every capillary, so we knew where there was blood flow across his face,” Dagan said.
The doctor harvested skin to make the inside lining of Dallen’s new nose, then took tissue from his forehead to build the outside. From Dallen’s thigh, Dagan took a big graft — with blood vessels — and used it fill in the depression in the boy’s face. To keep the tissue healthy, the blood vessels were routed into Dallen’s neck.
The key point came, however, when Dagan snapped apart the pieces of his model nose.
Using donor cartilage Mount Sinai provided for free, Dagan carefully cut each piece to match the pieces of the model — then used the cartilage to assemble the bony tissue into a structure that became Dallen’s nose.
Several months and three procedures later, Dallen flew home a happy young man with a nose, normal face and — as a bonus — cataract-free vision.
“Of all the challenging cases I’ve had, this was by far the most challenging,” Dagan said.
But it was so worth it.