Some people are born to play the piano. Some are born to be surgeons. Janice Lee was born to do either, but not necessarily both. And in choosing the operating theater over the musical stage, Lee has brought solace to patients literally defaced by rare skeletal disorders and other conditions of the head and neck. Indeed, since coming to the School of Dentistry's department of oral and maxillofacial surgery in July 2002 after earning her dental degree at UCLA and a medical degree at Harvard, doing residency training at Massachusetts General Hospital (MGH), and a stint at the National Institutes of Health, Lee has added more luster to an already established UCSF team of craniofacial surgery experts.

That the surgical field has typically been dominated by men has never deterred Lee. Mentored by Leonard Kaban, a former UCSF faculty member now at MGH, and nurtured by a father who insisted that all four of his daughters become professionals, Lee, a Toronto native, has raced past the hurdles she acknowledges still exist. "Among surgeons in general, being a woman means that to hold your own, you have to be exceptional."

Perhaps that is why the lure of orthodontics soon gave way to the thrill and challenge of surgery during Lee's first rotation in oral and maxillofacial surgery. "The face is such a focal point for feelings and psychological well-being that I was immediately drawn to patients who were disfigured by disease, the failure of bones to fuse, or who couldn't speak or function properly because of a misalignment of their teeth and jaws." Lee's interest in their welfare and the joy of helping patients, particularly children, with everything from vascular malformations on the face to facial asymmetry reflects a degree of sensitivity that she hints may be influenced by her gender.

"Operating on the face and neck is very invasive and potentially disfiguring in itself," Lee explains. This consideration may be less important to an elderly military veteran who simply wants the problem fixed, but essential to a child or young woman with a whole lifetime ahead. "Patients believe that women surgeons are more attuned to these fears. I like to believe I am."

Skill and sensitivity

When it comes to patients with fibrous dysplasia -- or those who fall victim to one of its offshoots, known as McCune Albright syndrome -- sensitivity must also be combined with skill. A chronic disorder that causes abnormal development of fibrous tissue inside the bone, fibrous dysplasia causes uneven growth, pain, brittleness and deformity in the affected bones. McCune Albright patients also develop hormonal disorders, which may lead to precocious puberty or growth abnormalities. Most cases are diagnosed before the age of 10, but a growth spurt during the early teenage years may also bring the condition to light.

"Fibrous dysplasia patients [split evenly among males and females] have bones that contain abnormal bone marrow and become deformed, which makes fractures a problem," says Lee. "This can affect bone development and height." There can also be limb-length discrepancies, spinal deformities and pelvic abnormalities -- not to mention disfigurement of the face and head. Lee, who has written about the impact of the condition on the optic nerve, spent her two years at the NIH working with 100 McCune Albright syndrome and polyostotic fibrous dysplasia patients -- one of the largest concentrations ever assembled. The experience has left her determined to find a solution that, ironically enough, obviates the need for surgery.

"I can do much to treat the deformity," says Lee. But when she sees a 31-year-old man with a head so large -- because of the growth of fibrous dysplastic lesions -- that she needs a chest X-ray machine to capture the image, the rarity of the condition is displaced by the grim reality of its toll. "I want to stop removing tumors from people's faces. I want to treat these patients without the blade." To do so requires that Lee understand the cause of the disease as well as she does the psyches of her patients and the physical landscape of bone and tissue. Not every institution would be able to accommodate these needs. Lee sees UCSF as a perfect match. "Apart from the excellence of the craniofacial team at UCSF, I came here because I knew I could do everything that I was trained to do." And while she may have given up her professional music career after 12 years at Toronto's Royal Conservatory of Music, Lee has not abandoned the notion of becoming a double threat. "At UCSF, I can be both a clinician and a researcher."