Weighing eight kgs, a bulky tumour drooping from the right side of a 31-year-old man's face, was always a source of misery since his childhood. Hailing from Odisha, the man was suffering from a rare condition called plexiform neurofibroma, a benign tumor of peripheral nerves which grew as he aged.
The man faced humiliation from several people due to his looks and had visited multiple hospitals earlier for partial resection (cutting out tissue or organ) of the tumor. At a major hospital in Odisha, his case was reviewed, surgery was attempted and was later abandoned due to uncontrolled bleeding.
He later came down to Bengaluru and visited Aster CMI Hospital for treatment, through a crowdsourced effort from Newslions Media Network Pvt Ltd and Milaap. He underwent 16 different surgical procedures over a period of six months to get rid of the tumor by a team of doctors, involving neurosurgery, plastic surgery, oncology, ENT, neuro-anaesthesia and ophthalmology, amongst the various departments.
The tumor covered the right side of face, head, neck, infiltrating into the right orbit and completely engulfing the right eye which made the surgical removal difficult and risky.
"His CT scan also showed his facial bones were destroyed by the tumor. Dealing with such highly complex cases often requires different modalities of treatment and a multi-disciplinary approach. The tumour gets blood supply from different blood vessels, which inturn grows the size of the tumour and also grows the blood vessels. If we removed the tumour as is, it would lead to massive bleeding which is what happened in the previous hospital. Hence, we blocked the blood supply to the tumour so he bled less," said Dr. Ravi Gopal Varma, Lead Consultant, Neurosurgery and Chief of Neurosciences.
Despite this, he did lose a fair amount of blood. He was transfused with 40 litres of fluids, blood and blood components while operating. Since his tumor was affecting his mouth opening, it was a challenge to get his breathing tube into his trachea for his first surgery.
Dr. Sathish M S Vasishta, consultant, Craniomaxillofacial Surgery, Aster CMI Hospital said, "Since the tumor had destroyed his facial bones, the challenge was to restore it after the removal of the tumor. With his CT scans data, a 3D printed skull model of his face was made to assess the extent of the tumor and design excision (removal) plan and reconstruction."
Prior to the surgery, he weighed 58 kgs and post that, it reduced to 44 kg. Once the tumor was removed, they took him up for reconstruction surgery after 48 hours.
"Most of his facial skin had to be removed as the tumor was densely adherent, resulting in a large composite skin and soft tissue defect over the entire right half of the face. The entire reconstruction surgery was done in two stages by using three flaps skin and muscles of both his thighs as well as the right forearm," said Dr. Madhusudan G, Lead and Senior Consultant - Plastic Surgery.
The patient was successfully discharged although follow ups are ongoing. He is doing well and has returned to his hometown, tumour-free and without complications.