Amrita surgeons remove 5 kg tumour from lower jaw ,reconstruct it using leg bone

Surgeons at Amrita Institute of Medical Sciences in Kochi removed a 5 kg tumour from the lower jaw and have reconstructed it using his leg bone.

Majeed, a 45-year-old father of four school-going children from Kerala’s Palakkad district, for the last ten years, had cancer affecting the left side of his lower jaw and was forced to live a secluded life. A tumour was so big that he had to hide his face. Such a large tumour has rarely been reported in medical literature. Thankfully, Majeed’s life changed for the better a few days ago when a team of 12 surgeons at Kochi’s Amrita Institute of Medical Sciences (Amrita Hospital) removed the humongous deformity – weighing a whopping five kilos and measuring 20 x 15 x 10 cm – in a surgery that lasted 12 hours.

A tumour started growing on Majeed’slower jaw in 2008 and protruded out to the left. The dense collection of bone and fibrous tissue led to a grotesque appearance of his face and enormous difficulty in swallowing and speaking, in addition to the social stigma. From being a social activist loved by all for his willingness to people, he became a recluse and stayed confined to his house. He and his family became dependent on the benevolence of others even for the basic needs of life, as he could not go to work and people began making fun of his appearance.

Majeed was treated at a reputed cancer center in Kerala where a part of his jaw was removed. However, there was a recurrence of the disease two years later and he had to undergo yet another surgery. He did well for a few years but developed the disease on the other side of the jaw three years ago. Since the disease was extensive and reconstruction difficult, he was suggested palliative chemotherapy. Despite continuing with chemotherapy for several cycles, the swelling on his face continued to enlarge, making his life unbearable. That is when Majeed heard of a similar surgery done at Amrita Hospital, and decide to visit Kochi for treatment.

Said Dr. Subramania Iyer, Chairman and Professor, Plastic Surgery and Head & Neck Surgery, Amrita Institute of Medical Science, Kochi, who led the team of surgeons: “Majeedunderwent a PET CT scan to determine the extent of the spread of the disease. Since it was found confined only to the jaw, we had extensive discussions with our tumour board and considered curative treatment for the patient. Majeed and his family decided to go for surgery despite being advised that the results may not be very good in the long term regarding disease control or having a good cosmetic and functional outcome. This is one of the largest ever reported lower jaw tumours of its kind. The huge mass was leading to grave complications. If the condition had persisted, Majeed would have found it impossible to use his mouth.”

The removal of a tumour, as well as the reconstruction of the lower jaw, was a great challenge. Surgeons had to carry out the procedure without endangering Majeed’s life. It involved detaching the tumour from the skull bone and keeping the reconstructed jaw in place. The tumour’s removal was complicated due to its huge size and the involvement of the entire lower jaw. The amount of blood loss was a cause of worry, but this was controlled by temporarily blocking blood vessels to that part of the face.

Said Dr Subramania Iyer: “A tumour including the entire remaining lower jaw was removed. Reconstruction had to be meticulously planned. Micro-surgical transfer of Majeed’s leg bone was carried out to construct a new lower jaw. The patient regained the function of normal eating and talking within a span of three weeks after surgery. The surgeons reconstructed his lips and he was discharged. Majeed’s tumour has been removed fully and he has been started on chemotherapy for the next two months to prevent it from coming back.”

After the successful surgery, patient Majeed said: “Because of this huge deformity on my face, my whole life had collapsed. I began staying indoors as people would be repulsed by my appearance and make fun of me. It is a huge relief to get a tumour off my face – it is almost like a second birth. If tumour had not have been removed, my life would have been in danger as cancer could have spread to other areas including my lungs. My tumour has been removed completely. I am truly grateful to the doctors of Amrita Hospital for enabling me to lead a normal life.”