Unique surgery for facial fracture gets soccer player back on the field

Trailing 1-0 with 15 minutes to play in an October 2022 regular season soccer game, St. Ignatius senior defensive player Philip Vlastaris went up for a header against a member of the opposing team.

“His head hit my forehead,” says Philip. “I was on the ground for about five minutes, then walked off. My vision was pretty bad, and the lights were hurting my eyes but since we were losing, I wanted to be there for my team and stayed on the sideline.”

The Wildcats scored three goals, winning the game. Then Philip’s dad took him to the ER. After X-rays, he was sent home with some pain meds. The next day, he saw Cleveland Clinic Head & Neck Institute’s facial plastic and reconstructive surgeon Peter Ciolek, MD, who formally diagnosed Philip with a severe fracture of his frontal bone.

“Philip had a depression in his forehead about the size of a golf ball. The front wall of his frontal sinus was fractured which is difficult to approach from a surgical standpoint,” says Dr. Ciolek.

The typical repair involves an incision over the top of the head, from one ear to the other. The incision is large, and can lead to swelling, a longer recovery and a significant scar.

After discussing options with Dr. Ciolek, Philip and his family agreed to take a unique minimal access approach using a very limited incision through the upper hair follicles of his left eyebrow, though which direct access to the fracture would be possible.

According to Dr. Ciolek, most facial fractures can be handled in a non-emergency fashion, and that was true in Philip’s case.

While he was in some pain, with his eyes pretty much swollen shut, Philip missed a few days of school, with surgery done on an outpatient basis four days after the injury occurred.

“The surgery itself was a little tricky because one side of the frontal bone was wedging the other side in, but I was able to get the bone pulled out, then used tiny titanium plates and screws to hold everything in position,” says Dr. Ciolek.

After surgery, with his team in a position to make the playoffs, Philip was eager to get back on the soccer field, which meant another big discussion between the family and doctors.

"Once I saw Dr. Ciolek, then learned there was a chance I could get a mask, I was determined to do whatever it took to finish the season."

“A local prosthetics/orthotics company scanned Philip’s entire head, then created a 3-D image of it from which to construct a custom protective mask. They were very specific and intentional as to what areas needed to be protected and where force had to be transmitted should he get hit,” says Dr. Ciolek.

From the day of his injury, through surgery and the time needed to make the mask, Philp missed just three regular season games and two playoff games.

He wore the mask through the playoffs (St. Ignatius won the State Championship game) and continues to wear it as a precaution while playing on a club team.

Dr. Ciolek will see Philip again for a routine checkup but confirms that with the bone healed, he has no limitations and a minimal scar.

Philip is grateful for the care he received. “When we were on our way to the hospital, I was bummed out because I thought my season was over,” he says. “Once I saw Dr. Ciolek, then learned there was a chance I could get a mask, I was determined to do whatever it took to finish the season.”