The titanium jaw was constructed and implanted onto a 30-year-old man whose jaw was removed due to cancer
The doctors at Fortis Flt Lt Rajan Dhall Hospital in Vasant Kunj performed a procedure to re-construct a jaw using 3D printing technology recently. The titanium jaw was constructed using a novel technology and implanted it onto the 30-year-old man from Faridabad. It gave him complete control over his mouth, which allowed him to chew food properly after seven years since his jaw was removed due to cancer. It also improved his confidence about his appearance. The procedure was successfully planned and performed by Dr Mandeep Singh Malhotra, Head of Department (HOD), Head, Neck & Breast Oncoplasty and his team at Fortis Hospital, Vasant Kunj (FHVK).
Speaking about the clinical challenges presented in the case, Dr Malhotra said, “The underlying SLE disease and reconstruction of the TM joint discouraged us from planning the conventional methodology of using the one’s own lower leg bone in form of fibula to reconstruct the jawbone. With SLE it was difficult to establish blood supply to the fibula bone, this method also involved losing a bone in the leg which cannot be compensated. The TM joint reconstruction could only be done by making a prosthetic joint and inserting it. Therefore, we thought of using 3D printing technology to develop a complete prosthetic jaw including the joint component using titanium which is the most biocompatible and light metal. The part of the joint which shall form the jacket around the upper part of prosthetic jawbone called as condyle was formed by ultra-high molecular weight polyethylene.”
On the reconstruction surgery, Dr Malhotra further added, “Simultaneous to our planning the patient was given splints and was inducted into intensive physiotherapy. The trial models for the prosthetic mandible were revised at different time intervals as the jaws got aligned. This process extended across nine months.
During the surgery, due to previous radiation therapy and surgery, there was extensive fibrosis and dissection was clinically difficult. A major problem encountered was the risk of injury to the facial nerve which is responsible for the facial expressions and movements. The nerve was carefully isolated and the joint component was fixed in place. The prosthetic titanium neo jaw was successfully inserted. The new TM joint was created, and the mobility of the lower jaw was thoroughly checked. The surgery went for around eight hours, it involved a very meticulous effort from identifying every nerve branch to placing each screw exactly as planned.
Dr Rajeev Nayyar, Facility Director, FHVK said, “Using 3D printing technology provides a new ray of hope to all the people who after winning over oral cancer can get their life back in their terms and as normal as it can be. It also brings down the fear of mutilation with oral cancer surgery. Now patients can take the right choice of getting timely surgery done for oral cancer, even if they lose a facial component it can be brought back. It augments our fight against oral cancer and will help save precious lives. I am glad to have capable and experienced doctors at our hospital who are ready to take new challenges every day.”
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