A pioneering technique helped surgeons rebuild a dysfunctional lower jaw and mouth, besides preserving a patient's ability to eat and speak after the removal of an invasive facial tumour.
This case study not only documents a successful surgical technique to create a fully functional lower jaw, but also reports the rare occurrence of a bone cancer (osteosarcoma) that spread from the patient's right femur to his jaw bone.
Usually, osteosarcoma is found in the leg bones and does not spread to other parts of the body.
"The bone tumour involved nearly all of his jaw bone, lower lip, chin, neck skin, tongue and both cheeks, approximately the lower third of the face and upper half of his neck," said senior study author Tamer A Ghanem. He co-authored the study with Francis Hall, Robert Deeb and Linda Hsu, all from Henry Ford Hospital, Detroit.
"We had to think outside the box to not only safely remove the tumour, but to allow for optimum functional outcome," added Ghanem, also director of the Head and Neck Oncology and Microvascular Surgery Division at Henry Ford.
The case involves a 21-year-old African-American male with a history of osteosarcoma, the eighth most common childhood cancer. It affects five million patients under 20 years and about 500 adults aged 15-30 years annually in the US, according to a Henry Ford statement.
The patient's osteosarcoma spread to his jaw bone about three years after the initial diagnosis. The facial tumour soon grew to nearly 10 pounds of tissue and bone, making it difficult for him to speak and eat. The patient required a feeding tube. Only three months after the surgery, the patient was able to talk and eat without assistance.
Earlier, the patient underwent multiple treatments including mandible resection, radiation, chemotherapy and cryosurgery at another institution. All treatments were unsuccessful.
Ghanem and Hall, devised a plan that would not only surgically remove the tumour and oral tongue, but rebuild the lower third of the patient's face - all during a 20-hour surgical procedure.
The surgeons performed a near total mandibulectomy (surgical removal of the bone from the lower jaw), and removal of the tongue, mucous membrane from the inside of both cheeks and lower lip. Ghanem performed the complex reconstruction of the face and jaw.
Ghanem will present this unique case at the poster session for the American Academy of Facial Plastic and Reconstructive Surgery annual meeting in Washington DC.