A little girl from North Dakota is thriving after an innovative surgery by a team at M Health Fairview Masonic Children’s Hospital in Minneapolis. To cure her cancer, doctors removed her jaw and rebuilt it using a bone from a different part of her body.

Elin Hoechst was 2 years old when doctors discovered a mass in her jaw after her mother noticed something wasn’t right.

“We were out at our lake cabin, and we had just come in from being out on the water, and she was having a snack, and I went up to wash her face and she started crying,” explained her mother, Anne Hoechst. “I noticed a few of her bottom teeth were loose, and it was two months before she turned three, and I was like, ‘She shouldn’t have loose teeth yet.’”

Elin was diagnosed with Ewing sarcoma, which affects just over 200 children and teens nationwide every year.

“It’s exceedingly rare,” said Dr. Luke Jakubowski, a pediatric otolaryngologist and assistant professor at the University of Minnesota Medical School. “If you look at kids that have a mandible Ewing sarcoma, that’s even more rare.”

He explained Elin started chemotherapy.

“Once I saw her MRI and that she had an expanding mass in her mandible we knew it was not good,” Jakubowski said.

There were two options for further treatment: radiation or surgery. Her doctors were concerned about radiation.

“It’s not the Elin at 3 or 4 years old we’re worried about, it’s the Elin at 10 or 20 or 30 years old down the road,” Jakubowski said. “What does that mean for her facial growth, her other risk of cancer, her functionality? That’s when we started to look at other options for her.”

Her medical team decided to move forward with a surgery where they would remove her jaw bone and replace it with bone from her fibula, the smaller shin bone.

“But the problem was her tumor was so extensive that her fibula was too small to accommodate her, to fill that gap,” Jakubowski said.

The team members collaborated and developed a groundbreaking plan. To buy time until she was bigger, they removed a large section of her jaw and replaced it with a 3D-printed metal prosthetic.

“I had heard of radiation and what it can do to your body, especially with her being so young and little, and she’s got a lot of growing to do, so that was very scary,” Anne Hoechst said. “We were very glad that we had another option even though it was a pretty scary one also.”

It was about an eight-hour surgery, and then Elin went back to living a normal life.

“She could eat, she could talk, she could grow and go to school, all while we were waiting to do her final surgery,” Jakubowski explained.

Doctors tracked her growth, and after about two and a half years, they decided it was time to take the prosthetic out and replace it with the bone from her leg.

Three cuts were made in the bone, which were connected along its blood supply to create the shape of her jaw.

“We want something that is her that will grow and last with her so that this can be her mandible for the next 80, 90 years or more,” Jakubowski said.

The surgery lasted roughly 12 hours.

“It was a very long day, probably one of my longest days,” Anne Hoechst said. “It was a very big relief just to see her [afterwards].”

Elin’s surgery was successful, and she is now three years cancer-free. She just finished kindergarten and is excited for summer break.

The next stage in her journey is getting dental implants for her bottom teeth, which were removed during her first surgery.

“We just cannot thank her doctors and the care she was in, the nurses and everybody were just wonderful,” said Anne Hoechst. “She has overcome so much and taught us a lot along the way. Don’t take the little things for granted. When everybody’s healthy, be thankful for it. Life can change in an instant with one phone call.”

Jakubowski believes this is the first-ever staged jaw reconstruction.

“We will write up her case so other surgeons can see this is what we did with Elin and what her disease process was and her outcome so that other people can consider this for other kids that are under 5 as well,” he said.