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City surgeons reconstruct jaw of cancer patient

In a rare surgery,plastic surgeons and cosmetic dentists at a city hospital joined hands to reconstruct the lower jaw of a cancer patient by using one of her leg bones.

27-year-old Sudha Gupta underwent first surgery in Aug 2010

In a rare surgery,plastic surgeons and cosmetic dentists at a city hospital joined hands to reconstruct the lower jaw of a cancer patient by using one of her leg bones and then attached tooth implants to it. The patient,who had a rare kind of tumor which resulted in the loss of the jaw bones,has shown good recovery six months after the surgery and is able to eat and talk.

Suffering from ameloblastoma,which attacks the lower jaw and starts dissolving the bone tissues,27-year-old Sudha Gupta underwent the first surgery in August 2010 when Dr RK Mishra,plastic surgeon at the Sushrut Institute of Plastic Surgery (SIPS),cut a piece of her fibula,the calf bone which supports the main bone of the leg,and redesigned it to gave the shape of the missing jaw bone.

“I had a swelling in the right side of the jaw since January 2010. The doctor first removed the last molar. Yet the pain and swelling persisted. When the dentist opened the gums to remove the pus,he could not find any bone in there,” said Sudha Gupta,“Then the doctors here suggested surgery and implant. Now,I do not have any problem in eating or speaking.”

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“Sudha had a large malignant tumour in the right side of her lower jaw which needed to be removed,but it would have left a gap where the jaw existed,” said Dr Mishra. Also,since the tongue is supported by the lower jaw,her speech as well as the functionality of her mouth,and her anatomy and aesthetics would have been affected. The doctors,therefore,decided to reconstruct the lower jaw bone from a piece of the fibula.

“The fibula is the supportive bone of the leg,the major function of which is to support the knee and the ankle joints. We removed the central part of the bone which is used for connectivity of muscles and hence has a very limited role,” explained Mishra,who took around six hours to remove the tumour,harvest the calf bone,reshape and place it in the gap left by the tumour. The surgery was done in August.

“The surgery,a rare one,was difficult because we not only had to reshape the piece of the calf bone in the shape of the jaw bone,but the vessels of the bone had to be attached to the nerves,arteries and veins of the jaw in order to keep the bone alive,” said Mishra. Next,the gums were made through plastic surgery.

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“Some two weeks back,three dental implants of titanium were drilled in the bone,which was tricky given the fact that fibula is a thin bone. While drilling in the implants,there was oozing of blood from the bone,which was a sign that the blood vessels running through the bone were well integrated and the bone implant was alive,” said Dr Vikram Ahuja,the dental surgeon who carried out the procedure.

“The implants are well integrated,we will be loading them with artificial teeth next month”,he said.

First published on: 19-02-2011 at 04:00 IST
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