Mumbai: Wadia doctors use a piece of leg bone to fix infant’s jaw

Dhruvi Devrukhkar before the operation and three months after the surgery

A nine-month-old girl has become one of the youngest in the country to undergo a complex jaw reconstruction after a rapidly growing tumour threatened to destroy that part of her features.

Dhruvi Devrukhkar, born to a Dadar couple, was detected with a rare benign tumour in her jaw when she was six months old.

"We were worried about her as she used to face difficulties in eating, drinking and swallowing. While it could have also led to an issue for her once she started speaking, we consulted the doctors at Wadia Hospital," said Mahendra Devrukhkar, her father.

For doctors, it was a challenge of another level. "The blood vessels were tiny and delicate. The strength of the bone was a concern. The reconstruction is done to bring stability to the jaw. At this age, the bones of the child are soft and they tend to break easily. The reconstruction of the jaw using such soft bones needed extra care while handling. But we were ready to go ahead with technical and Covid-19 precautions," said Dr Nilesh Satbhai, plastic surgeon at Bai Jerbai Wadia Hospital.

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A team of 12 doctors took 10 hours to remove the affected part and reconstruct it with a piece of a bone from Dhurvi's leg. "We had to cut the fibula bone from her leg into pieces and give it the required shape. We then fixed it with a plate and screws. Blood circulation to the bone was restored by joining blood vessels of the bone to the blood vessels of the neck," said Dr Satbhai.

He said the surgery was also challenging in terms of maintaining haemodynamics and giving anaesthesia as the surgery part was closer to the air way. "We had to be alert about what we were doing. Even a sudden blood loss of 100 ml would have made a huge difference since it was a child," added Dr Sathbhai.

During the surgery, the team also took care to keep Dhruvi's parents updated.

"While the parents were anxious to let such a child undergo the surgery, they saw how the tumour had grown in less than two months. While the surgery was on, we kept them posted at regular intervals. We knew it was difficult for them to wait outside an OT for 10 hours," said Dr Sathbai.

Post-surgery, the doctors had to remain more alert. "There are high chances of complications or failure because the blood vessels sometimes get blocked or there is no adequate blood supply. It needs close monitoring in post-operative period," said Dr Sathbhai.

Explaining the surgery, Dr. Minnie Bodhanwala, CEO of Wadia hospital said the jawbones play an important role as they enable people to open the mouth, speak fluently and communicate effectively. "The jaws also bear the teeth, which are crucial for biting and chewing. Besides, it maintains our facial proportions and dimensions. Hence, the absence or loss of a part of the jaw can lead to significant deformities and disabilities. We are happy that our team of doctors managed to do this complex surgery and give a new lease of life to Dhruvi," said Dr Bodhanwala.