Spent a complex reconstructive mastic on the jaw. Patient story

Patient story

“I’m going back to work. I’m very welcome there!”

A complex reconstructive surgery on the jaw was carried out by the specialists of P.Hertsen Moscow Oncology Research Institute, a branch of NMRRC.

When asked how our today’s heroine ended up found herself in P.Hertsen MORI, patient Lyudmila says that it was God’s providence. In 2018 she was diagnosed with first-stage cancer of the right jaw and had an operation for removing the tumor in her home area. Unfortunately, it relapsed after a while. The patient was given radiotherapy with a radical dose of 76 Gr. Step by step her mouth began to close. Or should I say, stopped opening. It was getting smaller and smaller.

– At first it closed just a little, then a little more, then a little more again, then not even a fingernail went in. I didn’t know what to do. But my wonderful daughter started ringing all the bells and got through to one of the biggest oncology clinics in Moscow. There, without really looking into it, they said that it was a relapse and, after prescribing chemotherapy, they sent me to my home area for treatment.

     But my daughter didn’t want to give up. And then she found information about the unique jaw operations that are performed at the P.Hertsen MORI in Moscow. The oncologist Anastasia Kondrashova welcomed us at the reception.

– A very young doctor, God bless her! – the patient continues her story. – She listened to us very carefully and prescribed further examinations. The Head of the Microsurgery Department, Dr.Andrei Polyakov, M.D., conducted a consultation and assured us: we will help!

– I will be grateful to him and all the doctors at the Institute for the rest of my life. Who do you think I am? Just a typical out-of-province patient. But the doctor was deeply affected by my problem and my pain, and they took me in for the operation.

   By the time Lyudmila was admitted to the “Head and Neck Department”, the name given to the Microsurgery Department at the P.Hertsen MORI, she had had a total loss of one third of her jaw, bone necrosis and destruction of the mandibular joint, which made it impossible to open her mouth, eat or speak. She was able to get rid of the underlying disease, a malignant neoplasm, but the treatment led to very serious functional disturbances. This was the body’s response to the radiation therapy.

– The standard in such cases is reconstructive surgery: either a microsurgical transplant of one’s own tissue or an artificial implant, but in this case, given her state of health and age, such a method would not have been effective,” recalls Dr.Andrei Polyakov.

The doctors decided to carry out a more complex, combined version of the operation.   First and foremost, it involved careful preoperative planning and computer-assisted 3D modelling of the lost joint and part of the jaw. Specialists at the P.Hertsen MORI and Dr. Sergei Epifanov developed an individual titanium graft to replace not only the lost part of the jaw, which would be removed by surgeons, but also the lost joint.

A joint socket has been created from a special medical plastic, where the new joint will be fixed and this will restore the lost function. While doctors were preparing the operation, the patient could only dream of opening her mouth.

One would think Lyudmila was a lucky one. To be in such hands! But it wasn’t random luck. It is a system. For more than 10 years the Institute has been working with Russian manufacturers of implants in Moscow and Novosibirsk. By that time the quality and speed of fulfilling a medical order, the cost price and reliability of the relationship made it possible to create any individual product a specific patient might need. The lead time is no more than 10 days. The whole institute was waiting for the parcel from Novosibirsk – all the participants of the regular morning conference knew about the dramatic story of the patient. The product arrived in time, and the operation was started. All the calculations on modelling turned out to be accurate, the product was duly made and of excellent quality. But that was not all.

The operation was supplemented with a fragment of tissue transplant from the forearm, which allowed the reconstruction site to be covered on the oral side and gave volume to the facial tissue for normal movement of the mandibular joint. In simple terms, we built up the cheek, and thus not only helped the joint to move normally, but also preserved the natural movement of the face and facial expressions. A smile is born here too!

Two teams of five surgeons were involved in the combined operation using microsurgery, facial plastic and individual titanium constructions at the same time. One team resected the lower jaw and joint, prepared the vessels in the neck for transplantation, and the other team formed the microsurgical graft, which was transplanted into the oral cavity. They worked for about six hours.

– Previously, such interventions were performed in stages, lasting 10-12 hours each, – said RAS Academician Prof.Andrey Kaprin, General Director of NMRRC, – but with the development of modern approaches in microsurgery and using digital technology, as well as the involvement of trained specialists in a one-stage process we managed to reduce time for such complex, combined operations almost in half.

Over the past few years, a plead of skilled microsurgeons, whose golden hands and bright heads reduce the time of both surgery and rehabilitation of patients, has grown at the Hertsen Scientific Research Institute, a branch of the National Research Centre for Radiology of the Russian Ministry of Health. After only 10 days, Lyudmila went home, having recovered all the necessary skills. And there were no dressings every other day at the surgeon’s, no queues at the clinic.

– But exactly we shall have a follow-up appointment in one month, – reminds Dr. Polyakov. – And a control study in a three months, checking how everything works and has established.

– I tolerated the operation well, – Lyudmila said to us at parting. – Living conditions are luxurious, like in a sanatorium, the doctors are great. Steel the diction is a bit “lame” so far, but it will pass. I have plans to go back to work, they really want me there.

NMRRC Press Service