Toddler charms doctors who treated complicated birth defect

February 13, 2017
closeup of Rhett Bausmith
Rhett Bausmith enjoys a snack while he waits on his checkup. He's undergone two surgeries and extensive therapy to treat his craniosynostosis. Photos by Sarah Pack

Rhett Bausmith freezes, stone still, as his surgeons walk in the door.

He knows he’s busted as only a boy, almost 2 and brimming with curiosity, can know. He just doesn’t know how busted he might be. With a fine pitching arm, Rhett had – just seconds before – hurled a ball through his examining room at the Medical University of South Carolina. As the surgeons gaze at him, Rhett remains like a statue, as if his immobility might somehow make him invisible.   

There’s slim chance of that. Plastic surgeon Jason Ulm walks closer. Rhett’s eyes grow larger, but then he sees how happy Ulm is as he crouches down and explores around Rhett's skull and eye sockets. All the tension drains from the little boy's face. He’s not busted. This is just life as usual for him.

Baby Rhett Bausmith before surgery
 This photo shows Rhett before his first surgery. Photo provided

Rhett has had doctors poking and probing his skull since his birth May 1, 2015, when he was born with a misshapen head. He had craniosynostosis, a birth defect that causes the bones in a baby’s skull to fuse too early. His parents, Timothy and Crystal Bausmith, were referred to MUSC Health, where they consulted with Ulm and pediatric neurosurgeon Ramin Eskandari. The surgeons joined forces to tackle what was one of the more complicated cases they had seen. Weighing it on a scale from 1 to 10, with 10 being the worst, Ulm stops to consider.

“It was a 9.”

They decided to treat him in two surgeries, spaced apart, and have MUSC’s bioprinting labs create 3-D skulls for both operations that surgeons could use to map out the procedure.

One of the skulls from the first surgery is quite the conversation piece in its glass box in the Bausmiths’ living room. Crystal says she shows everybody because it’s amazing how much progress they’ve made. It’s progress that has included not only the two operations but also Rhett having to wear a helmet to shape his head. The first surgery, August 21, 2015, focused on relieving pressure on Rhett's brain and included a barrel stave osteotomy, where cuts in a crisscross pattern are made in the skull. The second surgery, August 22, 2016, targeted removing the frontal bone and reconstructing the forehead and eye area.

Parents and doctors both are pleased with how Rhett is doing and the fact that he seems to have no developmental delays. Crystal says she and Timothy have become “baby head” experts, noticing when there may be something off with a child.

Adults talking as Rhett Bausmith sits in a chair in an exam room
Dr. Ramin Eskandari, left, talks with Rhett Bausmith's mom, Crystal Bausmith, while Dr. Jason Ulm, right, takes a photo of Rhett's head to document the progress. Photo provided

Timothy says it’s one of the main reasons they don’t mind sharing their story. “We met this lady once whose child’s head was kind of strange shaped, and she said, ‘Oh, it’s fine.’ But about a year or so later she found that her baby was so far behind developmentally that she said, ‘I wish I would have recognized this earlier.’”

Crystal says she’s on a Facebook page where many parents are seeking help on whether something may be wrong with their child and if they should get a computerized tomography scan. “Once you’ve been through this, you see the telltale signs, but many of these parents are saying, ‘It’s nothing,’ and our opinion is: Get a CT. Do it.”

That’s why Ulm and Eskandari are open to consults. Sometimes the cases aren’t clear cut and the defects can show up as a child matures. The doctors hope to offer telemedicine consults later this year to help pediatricians determine if a child needs to be referred to a specialist. Eskandari says there are proactive pediatricians and parents who don't think some things are right, but then there are others who want to do the wait-and-watch approach. If pressure is building up on the brain, that can be the wrong choice.

“Those are the cases when using telemedicine, we instantaneously can take a look. There are a couple features, where if you’ve seen a lot of these, you can just pick them out right away and say that person needs to come here, they need a scan or more evaluation,” says Eskandari. “There’s a line of pediatric offices that already have telemedicine, so we can piggyback on what they already have.”

Both Ulm and Eskandari say having the bioprinted, 3-D skulls greatly augments treatment. Eskandari sees a growing role for bioprinting, particularly with the creation of an MUSC collaborative craniofacial surgery 3-D technology team. The team’s able to consult and treat many conditions, including:

  • Positional plagiocephaly
  • Craniosynostosis
  • Congenital and acquired cranial defects
  • Fibrous dysplasia
  • Apert syndrome
  • Crouzon syndrome
A doctor feels toddler Rhett Bausmith's head
Dr. Ulm examines how Rhett's head is growing to see if any other corrections may later be needed.

The surgeons will be speaking at an upcoming joint conference of the American Society of Pediatric Neurosurgery and the American Society of Craniofacial Surgeons about the advantages of mapping out pediatric surgeries with 3-D skulls. The bioprinted skulls slice in a way that's similar to bone, so surgeons can practice on a replica of a patient's skull created using his or her scans.

Having this resource also helps the neurosurgeon and plastic surgeon collaborate. Both are critically important in the process of handling such cases. Ulm says Eskandari brings the neurosurgical component, given his expertise in working with the brain, while Ulm is looking more at the shape of the face and forehead.

Eskandari agrees both perspectives are needed. “I don't really think about how things look after you put the scalp back together because most of the time after we’re done with surgery, everything goes back the way it came. In this case, you’re physically changing the properties of the skull, but yet the scalp is away. So you have to be able to visualize all the soft tissues and having to change the underneath bone structure.”

In Ulm’s field of plastic surgery, where he does this on a daily basis, he can see the nuances. For example, if they expand the skull, he knows the tips of the skull bones are going to be protruding and what amount of bone may need to be shaved off. Ulm says the techniques are constantly evolving, and it’s great that groups that used to work somewhat independently are collaborating and improving techniques together.

Rhett Bausmith between his father's arms in an exam room.
Rhett Bausmith looks up at his father, Tim Bausmith, as he eats a snack while waiting for Dr. Jason Ulm and Dr. Ramin Eskandari to examine him.

In the end, it means boys such as Rhett can do what they are born to do, without being ridiculed for a misshapen face, or even worse, having developmental delays. Eskandari says the staged surgery allowed them to work with Rhett’s natural growth to provide more correction from the first reconstruction. They’ve been able to get the head shape they wanted and better eye alignment, and best of all, brain growth has not been impaired. Developmentally, Rhett’s right on track.

The main concern now for the Bausmiths, who have four children, is the normal kind of fare they are used to handling. Crystal’s main concern is keeping Rhett, whom she describes as her CrossFit kid, from damaging his nicely-repaired skull. Rhett likes to climb and flip over things.

“He loves to throw. He will fill up my bathtub,” she says, laughing that he’s doing so well. “He will go around the house looking for things to fill up the bathtub. He threw his trucks in there. He threw the whole baby stroller in there. I’m like, ‘I don't even know how you’re picking it up.’”