A middle-aged man from West Bengal came to Manipal Hospitals Whitefield, Bangalore, for a rare bone tumour surgery during lockdown

 Kolkata : As the saying goes that “A stitch in time, saves nine”, appropriate and timely treatment by experts can stop the worsening of several health conditions, including tumours.
A 42-year old patient, hailing from West Bengal presented to the Manipal Hospitals, Whitefield with severe jaw pain and swelling during the lockdown. Due to the large tumour size involving the entire jaw he had difficulty in chewing, swallowing or talking.  CT scan showed a very large multicentric expansile lesion destroying the jaw bone at 3 places. Biopsy revealed it was a rare tumour called Ameloblastoma, notorious for being locally aggressive and recurrences.

Surgery is usually the first-line management in such tumours and failure to remove the tumour completely is associated with high chances of recurrence. In this case, too, the patient had undergone surgery twice at his native place, but developed recurrence. He finally reached out to the Manipal Hospitals, to seek expert opinion and care, unable to bear his severe jaw pain and worsening condition. He was successfully operated by a multi-disciplinary team of surgical oncologist and plastic reconstructive surgeons. “About 90% of the jawline at one-side had to be removed, as his entire jaw was involved with tumours. It took almost 4 hours to complete the surgery.” elaborated Dr Ashwin Rajagopal, Consultant-Surgical Oncologist, Manipal Hospitals Whitefield. Ameloblastoma, though benign, has a high recurrence rate. It keeps growing and can destroy the bones in the affected area extensively, if not removed completely. A pathologist often examines the rim of the tissue during the surgery, to ensure all the tumour cells have been completely removed, a procedure known as surgical margin. “Achieving radical resection of bone and floor of mouth muscles with negative oncological margins was paramount to prevent another recurrence. I wanted to be 100% sure that the entire tumour has been removed" further explained Dr Ashwin RajagopalBut only a part of the problem was solved. The patient also required a major jawline reconstruction surgery to aid swallowing and speech. This complicated plastic reconstruction surgery lasting over 8 hours involved removing his femur bone, reshaping it to match the jaw and fixing the same at the jawline. “It was a challenge in managing recurrent ameloblastoma to achieve complete removal and reconstruction, especially when the tumour is extensive. Creation of new jaw bone was tough since we had to restore both aesthetics of face as well as the function of the jaw so that he can chew, swallow food and talk normally" further added Dr Ramani CV, the Consultant – Plastic, Reconstructive and Cosmetic Surgery  at Manipal Hospitals WhitefieldThe patient has recovered well after the surgery. Post physical rehabilitative therapy for mastication and speech function he is leading a normal life Says Dr. Sunil Kumar – Consultant – Plastic reconstructive and Cosmetic Surgery Manipal Hospitals Whitefield. Highlighting the importance of seeking appropriate medical management for serious conditions during the ongoing pandemic Dr Ashwin added “One cannot wait for surgeries like this. Such patients need immediate medical attention and treatment to prevent complications.”


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