| Gracie Coblentz and Reza Rahbar, DMD, MD
do happen—just ask Tricia and Matt Coblentz.
In the spring of 2002, with Tricia just four months into her second
pregnancy, their local obstetrician indicated that an ultrasound
had revealed a sizable, solid mass growing from their baby girl’s
mouth. Scared and uncertain, the couple turned to Children’s
Hospital Boston to determine what this meant for their unborn child.
Tricia and Matt were referred to the Advanced
Fetal Care Center (AFCC), where mom and baby underwent a series
of diagnostic tests to establish the cause of the mass. A magnetic
resonance imaging (MRI) scan confirmed the baby’s diagnosis
of a benign congenital oral teratoma—a rare type of germ cell
tumor that can hold serious implications for both the baby and mother.
The couple met with a multidisciplinary team of AFCC specialists,
who shed some light on the diagnosis, as well as treatment options
for the baby. “The team determined that it was critical for
Tricia to carry the baby until she reached a viable stage for delivery,
as the longer the baby remained in her mother’s womb, the
greater her chance for survival,” says Reza
Rahbar, DMD, MD, associate in Otolaryngology, who managed
much of the baby’s care.
With the help of their family and friends, Tricia and Matt made
the difficult decision to continue with the pregnancy, putting their
faith in the AFCC team. They also decided to name their daughter
Gracie. “Everyone kept saying that our little girl was in
God’s grace,” says Tricia. “We had every hope
that she would survive, and we wanted her name to reflect that hope.”
|Countless physicians, nurses and social workers
contributed to Gracie’s care, including Tricia Smythe, RN, a
nurse in the NICU AFCC team members Carol Barnewolt, MD, and
Judy Estroff, MD, of the Department of Radiology; Linda Bulich,
MD, and Laura Myers, MD, of the Department of Anesthesia; Russell
Jennings, MD, of the Department of Surgery; and John Mulliken,
MD, of the Division of Plastic Surgery.
A little more than seven months into Tricia’s pregnancy,
another MRI revealed that the mass had grown, extending down into
Gracie’s throat and obstructing her airway. Fearing that her
windpipe would be completely blocked if the mass grew any larger,
the team performed an ex utero intrapartum treatment (EXIT) procedure
just two days later.
“An EXIT procedure is a special method of delivery in which
the head and shoulders of the baby are extracted,” explains
Rahbar. “The lower body remains in the womb so the baby continues
to receive oxygen through the placenta until the windpipe has been
cleared and an effective airway established.”
Clinicians usually have up to 45 minutes to create an airway for
the baby. However, Tricia’s placenta ruptured, leaving Rahbar
with only a few moments to perform a tracheotomy—a small incision
in the throat to insert a breathing tube—so Gracie could breathe
on her own.
She was then fully delivered and taken to a separate operating
room where the majority of the teratoma was removed from her mouth.
She weighed just two pounds, nine ounces following the removal of
the mass, and remained in the Neonatal Intensive Care Unit (NICU)
for three months. “I only saw Gracie for a moment after she
was born,” recalls
Tricia. “But right away she had so much spirit and fight in
her. She was definitely a survivor from that very first day.”
Gracie has since undergone 11 operations, including removal of
the remaining teratoma from her mouth, reconstruction of her windpipe
to remove her tracheotomy tube and repair of her cleft palate, but
only minor evidence of her once-serious diagnosis remains. “Gracie
has been tremendously successful thanks to the dedicated efforts
of countless physicians, nurses and social workers,” says
Today, the 1-year-old is thriving, with smiles for everyone she
meets. “Gracie is really doing wonderfully,” says Tricia.
“She is eating normally and making all kinds of noises. She
is such a happy baby. We can’t thank Dr. Rahbar and all the
amazing caregivers at Children’s enough.”
“This is one of those once in a lifetime cases,” adds
Rahbar. “Gracie truly is a miracle baby.”