A woman in her 20s recently underwent a complex facial reconstruction procedure at Rambam Health Care Campus in Northern Israel to address severe disfigurement caused by a malignant cancerous tumor.
During the surgery, a bone segment from her leg was harvested and used to replace a portion of her lower jaw. Subsequently, additional facial reconstruction was completed by transplanting tissue taken from her hip area.
Dr. Saleh Nseir, a senior physician from the Rambam Oral and Maxillofacial Surgery Department, shared that they were "faced with a significant challenge when the patient came to us. She had a complicated oncological tumor that required surgical attention. The task involved not only the removal of the tumor but also dealing with the extensive damage it had caused. The aim was to restore her jaw's functionality and help her regain the quality of life she had prior to the tumor's development."
The routine procedure in many healthcare facilities involves restoring the jaw and other facial bones using tissues and bones harvested from different parts of the patient's body. However, in this case, the complexity arose from the need to identify diverse tissues capable of healing a relatively large damaged area. After the young woman's case was reviewed by a team of cross-functional experts, they decided on a two-phase approach. The first phase involved using a bone from the leg to mend the defect in the jawbone. The second phase involved using soft tissue from the hip region to rectify the external damage on the young woman's cheek and lip.
The surgery was meticulously premeditated and executed with the aid of a 3D simulation. This advanced tool helped the surgical team anticipate and prepare for the intricate aspects associated with this operation. Spanning over ten hours, the procedure was carried out by a diverse team of specialists. This team comprised physicians from otolaryngology, head and neck oncology, oral and maxillofacial surgery, and anesthesiology.
A race against time
Relying on the strategic blueprint provided by the digital surgical plan, the team of surgeons began the operation by excising the cancerous tumor from the lower region of the young lady's face. Following this, the reconstruction stage was initiated where a portion of the tibia was harvested, meticulously shaped to compensate for the deficiency in the patient's jawbone. The harvested bone was repositioned while maintaining its vascular connection to the leg, mitigating the risk of bone death.
The culminating step involved transplanting soft tissue, sourced from the patient's thigh. Throughout the procedure, the surgeons utilized a microscope to intricately link tiny blood vessels, sourced from various parts of the patient's body. This intricate vascular network was established to ensure a sufficient blood supply to the newly grafted tissue, thereby securing the success of the operation.
"We were in a race against time," Dr. Nseir explained, "Tissues and blood vessels can survive for approximately two hours outside their usual location. Within this window, we have to successfully connect the tissues and blood vessels and make sure everything is operational, ensuring the relocated tissues can continue to function in their new position."
Dr. Yotam Shakedi from the AG Department of Head and Neck Surgery said: "Due to the extensive damage caused to the young woman's face, we were forced to provide a truly complex surgical solution, both in the size of the operation and the execution of the various stages in one surgery. There is no doubt that successful treatment in such cases is only possible in a place where various medical fields meet for collaboration. The young woman is now recovering and we are very optimistic about the results of the surgery."