At the age of three, Mohammed Othman didn’t just have gruesome facial features, he literally had none. The Iraqi child, whose parents run a grocery store in Baghdad, was born with a genetic abnormality that retarded the development of his facial muscles and bones leaving him without half a nose, an eye socket, an upper lip and jaws. “All he had was a swollen hole through which his parents fed him and he was able to move his tongue,” explains Dr SM Balaji, reputed dental and craniofacial surgeon. Having seen the extent to which his face was contorted and under-developed, the Iraqi government’s health department sought the assistance of Dr Balaji in trying to give the child some semblance of a face. “His brain and eyes were working fine. As soon as we figured that out, I knew that we could do something for him,” he adds.
The doctor ascertained that Othman’s condition was a genetic abnormality arising from an improper conduction of signals from the child’s brain when he was a foetus. “The neural crest cells travel across the child’s body and form organs and bones. When the communication between the brain and these cells becomes ineffective, these abnormalities occur,” he explains. The child thus had a craniofacial cleft deformity. The child was brought to Dr Balaji’s hospital a couple of months ago and even the seasoned surgeon was taken aback by the daunting challenge of fixing his face. “It had to be done in two stages -- first, his lips needed to be formed and then his eye needed to be set. He needed a bone transplant for his jaws and his entire nose and the left side of the face would have to be shaped, so that it looked normal,” he explains.
The road to semi-normalcy for Othman began when Dr Balaji started the formation of the upper lip using tissue from his lower lip. This surgery alone took 4 hours as the muscles around the lip are sensitive and have to be handled with care. He also rotated the skin and muscles on his face so that the gaping hole that was his mouth closed considerably.
While this was the easy part, the difficult part of realigning the facial field bit by bit, came next.
“We harvested two of the child’s ribs near the costochondral junction (the ribs’ growth centre) and created a lower jaw and jaw joint,” he says, “The bone is wrapped in a colloidal sheet of tissue that has growth factors and BMP (protein). This stimulates new bone formation by stimulating stem cells and progenitor cells to form bone cells,” he adds. Once the jaws were formed, he transplanted it into the child’s face.
After setting a nose using available tissue, Dr Balaji finally set to work on the left eye. “I used a Y-plate (Medial Canthoplexy), a technique that I pioneered. This ensures that the eye sits inside the artificial socket. Though the eye is intact, it will take some time for vision to return as it has never ‘seen’ before,” he said. The child has returned to Iraq for now, but Dr Balaji is looking forward to the next surgery that will give him a left ear.