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 Single stage Removal & Reconstruction of jaw tumor in a 1 year old boy for the first time and rehabilitation with dental implants

17/6/2015

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For the 1st time a rare type of aggressive facial and jaw bone tumor for 1 year old boy was removed through the mouth and the jaws reconstructed using rib graft, titanium mesh and bone morphogenetic protein. Rehabilitation was completed using dental implants and ceramic prosthesis to replace the missing teeth.  

A path-breaking surgery has helped an infant to recover from a facial disfigurement and life threatening ailment owing to a tumor in the jaw bone. The boy’s parents were very worried and they had approached many centers across the globe but the doctors there were hesitant to treat the one-year-old Maldivian boy due to the complexity of his condition. Dr. S.M. Balaji renowned for his expertise and dedication in Maxillofacial surgery successfully accomplished this complex task.

The Maldivian boy Saalik was 1 year old when he was referred to the hospital. He was suffering from a rare form of jaw bone disease called Osteodystrophy. It is a kind of tumor wherein the jaw bone dissolves gradually and gets replaced by soft tissues. Owing to this, his face was disfigured and his ability to eat and speak was becoming increasingly difficult. The disease severity was rapidly increasing from the time he was just 8 months of age.

Conventionally, for such cases, the only treatment is surgery which should be done when most of the growth ceases, i.e. at about 15 years of age. But in this instance, the extent of the tumor was vast involving the entire upper jaw and almost whole of lower jaw except the jaw joints. Distorted jaws will impede the growth of other facial bones also. Hence the only option was to intervene surgically immediately.

In a six-hour surgery, the diseased portions of upper and lower jaws were removed. A bone graft was taken from the boy’s rib and along with a customized imported Titanium plate was used to reconstruct the jaws. To enhance bone healing rhBMP-2 was also placed.

Recombinant human Bone Morphogenetic Protein is a scientifically prepared version of a protein that is already present in the body that promotes new bone growth. It stimulates the patients’ own cells to rapidly form new bone and quickly heals bony defects. This miracle protein also finds use in treatment of other maxillofacial defects like cysts and fractures. Other than the US, this centre is the only facility in this part of the world to adopt this technology with great success.

The widespread extent and severity of the disease and that too at such a young age complicated the problem. Microvascular surgery is tough due to the very fine blood vessel structures. Surgical strategies were planned meticulously using advanced CT scans. The innovative 3-in-1 surgery avoided the need for further surgeries. For the first time such an attempt to completely rehabilitate the tumor in a single stage was done.

The highlight of the surgery was that the entire procedure was done from inside his mouth so there will not be any visible scars on the child’s face. Following good new bone formation, his rehabilitation was completed with dental implants and fixed ceramic crown prosthesis to replace his missing teeth. He is able to eat and chew well. The boy’s parents are very happy that their child’s ailment has been successfully treated and that he is able to breathe, eat and speak well while at the same time his facial appearance is also normal again.

Saalik’s positive response and normal health have showed us how this surgery and stem cells treatment can be potentially used for reconstruction. 

Normal appearance of the baby at 6 months of age before tumor growth
Huge disfiguring facial swelling affecting the appearance and inability to close the mouth and speak properly
3DCT scan view showing complete destruction of the upper and lower jaw bone
Huge expansile bone tumor involving the entire maxilla was surgically exposed
Huge tumor was removed intraorally
Maxillary tumor mass in toto
Completely excised mandible along with the tumor mass
New bone formation following reconstruction of the jaw bone using costochondral rib graft and rhBMP2 bone protein
3DCT scan view showing good bone formation
Before and after tumor resection without any visible scars on the face
Dr. S. M. Balaji with the boy following successful jaw reconstruction
Implant fixation in the newly formed alveolar jaw bone
Dental implants fixed into the jawbone with good stability and retention
Cosmetically well blended implant prosthesis given
The boy and his parents are happy to have the tumor treated well without scar and for new teeth with implants
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Successful removal of large oral tumor and reconstruction without any scars

23/2/2015

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This is a case of adenomatoid odontogenic tumor involving maxilla and zygoma on the right side. Patient came from West Bengal with the complaints of huge swelling in the right side of the face. The swelling was progressive and initially he had pain in his right upper jaw and cheek. He had consulted many doctors for removal of this huge swelling without any scars but they were refused to do intraorally. One of his friends referred him to us for the treatment.

After thorough clinical, radiological and histopathological examination, Maxillofacial Surgeon Dr. S. M. Balaji successfully removed the entire tumor mass intraorally along with sufficient clearance to avoid recurrence. Following surgery his facial appearance was improved dramatically and after a week satisfactory healing was achieved intraorally. Patient feels very happy to have the entire correction done in a single surgery and done without any visible surgical marks on his face.

Preoperative view showing swelling in the right side of the face obliterating the nasolabial fold
Note the elevation of the ala of nose on the right side to to huge swelling
Note the localized bluish discoloration of the swelling suggesting of the cystic change
Preoperative 3DCT scan view showing complete destruction of bone due to odontogenic tumour on the right side involving maxilla and zygoma
Intraoperative view showing complete removal of the lesion along with the affected bone intraorally
Complete excision of the tumor mass in toto
Immediately after suturing
Postoperative intraoral view following 10 days from surgery showing satisfactory healing
Enhanced appearance following surgery without any scars on the face
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