Nagpur: Doctors at a private hospital in the city have not only saved vital organs like brains and eyes of a 52-year-old schoolteacher but also performed probably the first complete mandible reconstruction surgery after she lost her entire jawbone in double black fungus attack between May and June.
The successful placement of an artificial jaw is also the first permanent rehabilitation of a mucormycosis patient in world, said Dr Chandrashekhar Bande, consultant head and neck cancer and facial plastic surgeon, Alexis Multispecialty Hospital.
Discharged now, the woman has regained her original look but will have to wait for another two months for fixing permanent dentures. Till then, she would be on liquid diet.
Dr Chandrashekhar Bande, consultant head and neck cancer and facial plastic surgeon, designed and patented the implant.
The multidisciplinary team of doctors from the hospital, including infectious disease specialist Dr Nitin Shinde, oral surgeon Dr Ashish Maheshkar and prosthodontist Dr Prajakta Thool, decided to opt for complete resection under the supervision of anaesthetist Dr Jagdish Bhalerao at the hospital.
Dr Bande said, “There are some more similar cases but not of this severity. We needed 15 to 20 days along with technical team to design the prosthetic as the patient’s facial and jaw and functions. As per available literature, one reconstruction surgery has been reported from Europe on an 84-year-old. This is the first rehabilitation for any patient in Asia and first on a mucormycosis patient in the world.”
The patient had a history of diabetes, hypertension and hypothyroid. In conventional cases, a part of knee bone (fibula grafting) is used to reconstruct the jaw. Considering the age and condition of the patient and potential post-surgery re-infection complications, this option was not feasible.
Fibula grafting would have resulted in poor facial aesthetics and caused emotional distress, said the doctors. The reconstruction was performed using advanced 3D printed titanium implant customised for the 52-year-old teacher.
According to the hospital, the reconstruction surgery was performed on August 18 and after two weeks of monitoring, she was discharged with stable condition and no strains of mucormycosis.
In April this year, the teacher had tested Covid positive and was admitted. On May 11, she was diagnosed with the black fungus infection. Due to her critical condition, a marginal mandible resection surgery along with resection of infected region in the lower jaw was performed by Dr Bande. Later, the team decided to opt for complete resection.
The procedure was done to prevent further spread of infection to vital organs such as eyes and brain. Unfortunately, just a month after the first surgery, the patient was again diagnosed with black fungus infection. The CT scan images showed mucormycotic osteomyelitis in the complete lower jaw.
Dr Tushar Gawad, director (administration) at the hospital, said, “Such complicated cases require a multidisciplinary approach which can only be possible at a multispecialty tertiary care hospital like Alexis.”
About Artificial CRB
* Artificial CRB customised complete mandible designed and patented by Dr Chandrashekhar Bande
* Ideal reconstruction provides a solid arch to articulate with the upper jaw, restoring swallowing, speech, mastication and aesthetics
* The complete lower jaw was reconstructed using advanced 3D printed titanium implant customised for the patient
* Dr Bande and the team collaborated with LUCID Implants
* Team of engineers, surgeons and biomedical designers at LUCID used sophisticated computer software and advanced 3D printing technologies to design and manufacture customized full mandible implant as per patient’s facial anatomy
The case
* In April this year, a 52-year-old teacher from Wanadongri tested positive and was admitted
* On April 21, she was discharged but within days reported severe toothache in her lower jaw, followed by excessive swelling, trauma and hallucinations
* On May 11, she was diagnosed with mucormycosis infection
* Dr Bande performed a marginal mandible resection surgery along with resection of infected region in the lower jaw
* Later, Dr Bande and team decided to opt for complete resection
* Just a month after the first surgery, the patient was again diagnosed with black fungus infection
* The CT scan images showed mucormycotic osteomyelitis in the complete lower jaw
* The immediate action was to completely replace the lower jaw with a functional implant to prevent further spread of infection
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