A Nigerian, presently in Mauritius, benefits from life-saving surgery at the Apollo Bramwell Hospital, following successful removal of a rare oral tumor.
The young adult had a history of surgery for a tumor in the Mandible (lower jaw) in Nigeria about 3 yrs ago where the left part of the jaw was partially resected and reconstructed with a prosthesis and bone from the hip. Although he recovered following the surgery, he reported to have a painful swelling on the left side of the head and face which restricted his mouth from opening and thus difficulty in swallowing.
The young man had been consulting various ENT specialists and plastic surgeons on the island who felt his condition was too advanced and far complicated to be operated. He was advised to travel abroad for surgery. He reported that he was managed conservatively by aspiration (tapping of fluid from the tumor). Finally he was referred to the Apollo Bramwell Hospital (ABH), ENT department through a mutual friend who was confident that the specialists could help him.
A multidisciplinary team at ABH was appointed, comprising of experts including Dr Dinesh Murmu, the ENT and Head & Neck Surgeon, and Dr. Arvind Narayan , the Maxillofacial surgeon. Upon investigating the patient’s medical history, the specialists discovered that he was previously operated for a condition known as ameloblastoma. The CT scan confirmed that it was indeed a recurrence of the tumor in the mandibular, temporal and iInfratemporal region.
Following admission of the patient, routine blood tests, a panoramic X-ray, a repeat CT and Carotid Angiogram were performed to delineate the tumor, and plan for the surgery. After approximately 8½ hours of surgery by the specialists, the tumor was resected as a whole with preservation of the facial nerve. Frozen sections (histopathological examination during the surgery) were conducted to ensure the entire tumor was cleared. The procedure was successful and the tumor measured 7cm x 4 cm x 3 cm.
In this patient, the recurrent tumor from the jaw bone had grown extensively; invading a complicated and inaccessible part called the infratemporal fossa and occupied most of the temporal region of the left side. It was very large stretching from the lateral part of the left eye (temple region) to the area above the ear and the upper limit was within the temporalis muscle in the skull. The CT scan revealed that it was encroaching upon the maxillary sinus and the sphenoidal sinus in the brain. It was closely related to the internal carotid artery which is the main vessel supplying blood to the brain.
The infratemporal fossa is a challenging area to operate due to the presence of vital structures including the major vessel in the head and neck. The ensuing internal carotid artery bleeding can be life threatening. The facial nerve is another critical structure which had to be preserved since any injury to this would result in permanent paralysis of one side of the face. Despites all these hurdles the expertise of the specialists prevailed and they managed to successfully remove the tumor.
Jaw tumors are relatively uncommon with ameloblastoma having an incidence of around one percent of all oral tumors. Though it is a benign but nevertheless a very aggressive form of tumor arising from odontogenic (tooth forming) cells, they have a very high rate of recurrence and can invade structures adjacent to the jaw bone. Unfortunately, these tumors can only be treated by surgery and do not respond to radiotherapy or chemotherapy like other cancers.
The Nigerian patient had an excellent recovery. No blood transfusion was needed, the facial nerve function was intact and the mouth opening and jaw alignment were normal. Patient said “I feel good about the surgery and the recovery is coming gradually. The treatment by the ABH specialists was great, especially Dr Dinesh Murmu and Dr Arvind Narayan”. The doctors stated that if the tumour was left untreated it could have invaded the orbit and the skull with fatal results. The Patient was discharged after three days. It was noted that very few such cases are reported in the medical literature, since tumors are treated well before they attain such an enormous size.
A growing number of international patients have travelled to Mauritius in the hope of world class medical treatment. Since the opening of the Apollo Bramwell in 2009, the hospital has treated more than 11,000 international patients.
Juste quelque mots pour vous remercie de votre acceuille chaleureuse, toujours competent avec les patients, surtout les infirmieres pediatriques, pour Sooreeta, Dr Kevin Teerovengadum, Dr Joomye, Mr Joe, Infirmiere Dorothe, ange gardienne Reshma et la chirurgienne Dr Reshma. Moi je suis fidele a l'hopital Apollo depuis 2009 par l'acceuil et leur sympathie. Je remercie tous les services. Meme ma fille, T., la patiente, elle veut pas quitte l'hopital.