The effectiveness of microsurgery in treating large, complex facial lesions

From November 18-22, 2024, E Hospital continues to coordinate with Operation Smile, University of Medicine and Pharmacy, Vietnam National University, Hanoi to organize an international microsurgery program to organize screening examinations and microsurgery treatment of head and neck cancers and diseases of the seventh cranial nerve...

The program supports all surgical costs for patients with large tumors or cancers in the maxillofacial area; patients with maxillofacial defects; and facial nerve paralysis.

Faces that don't know how to smile

Patient DHH (male, 35 years old, Nghi Xuan commune, Ha Tinh province) had a mandibular defect/mandibular ameloblastoma. During the examination, the doctors discovered that the patient's jaw bone showed signs of serious inflammation, and if surgery was not performed soon, it would endanger the patient's life.

Immediately, doctors at E Hospital consulted with Professor Nguyen Tai Son - Medical Advisor of Operation Smile Vietnam, Vice President of the Vietnam Association of Plastic and Aesthetic Surgery; experts from EDA Hospital, Taiwan (China) ... determined that the patient had osteomyelitis of the lower jaw after surgery to remove ameloblastoma and create a fibula without vascular connection 7 months ago. The patient was indicated for surgery to remove the inflamed bone and create a fibula flap using microsurgery techniques.

Professor Nguyen Tai Son - Medical Advisor of Operation Smile Vietnam, Vice President of Vietnam Association of Plastic and Aesthetic Surgery examines the patient.

Dr. Nguyen Hong Nhung, Department of Dentistry, E Hospital (lecturer of the Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy, Vietnam National University, Hanoi) is a leading expert in microsurgery techniques in the maxillofacial region, with more than 10 years of experience performing about 1,000 microsurgeries for many patients with maxillofacial diseases, along with doctors from the Department of Dentistry and the Department of Plastic and Aesthetic Surgery, E Hospital, who performed this surgery.

According to Dr. Nguyen Hong Nhung, such microplastic surgery usually lasts about 8-10 hours. After surgery, the patient can stop the pain, practice swallowing, practice speaking and life can return to normal.

Currently, doctors at E Hospital have applied micro-surgery flap plastic surgery techniques to treat many cases of diseases related to maxillofacial cancer, especially oral cancer, with many good results, bringing high treatment efficiency to cancer patients, while helping to restore function, anatomy, aesthetics as well as psychology, improving the quality of life for patients.

Ms. PTL (female, 40 years old, Hai Duong) had a left maxillary defect after surgery to remove a maxillary carcinoma, dissect the neck lymph nodes, and create a sphincter flap 2 years ago. Currently, the patient has a sunken left cheek below the left eye socket. After consulting with experts from EDA Hospital, Taiwan (China), the patient was prescribed surgery to create a maxillary defect using microsurgery techniques.

The youngest and most special patient examined in this program was NTA (male, 11 years old, in Quang Ninh province) who came to the clinic with a deformed jaw and face, loss of soft tissue of the upper and lower lips, lip and nose contracture, unable to close the mouth, and severely misaligned teeth.

It is known that the patient suffered from a defect in the oral and facial tissues after a domestic accident caused by a firecracker exploding in the face in 2022, leading to a broken upper jaw, lower jaw, loss of upper and lower lips... and had undergone maxillofacial surgery at a medical facility. Knowing about the program through an introduction, the skinny, hard-working mother determined to bring her child to Hanoi with the wish to find a smile for her child like many of her peers.

Realizing that this was a serious case, the experts conducted a consultation to determine that the patient had severe defects and contractions in the oral and facial tissues. Immediately after, the patient was indicated for surgery to release the contractions and cover part of the defect with a microsurgical flap.

These are 3 of 8 patient cases examined and consulted by doctors from E Hospital on the first day of this meaningful and humane program.

Microplastic surgery gives patients a new face

Dr. Nguyen Tan Van, Deputy Head of the Department of Dentistry, Hospital E; Head of the Department of Oral and Maxillofacial Surgery, University of Medicine and Pharmacy - Vietnam National University, Hanoi shared that when patients have large and complex facial injuries, choosing the microsurgical reconstruction method to reconstruct the patient's defects is the optimal choice and brings many benefits to the patient.

Dr. Nguyen Tan Van, Deputy Head of the Department of Dentistry, E Hospital, examines a patient.

Microsurgery is one of the most advanced techniques in reconstructing maxillofacial defects in the world as well as in Vietnam today. If in the past, many maxillofacial injuries were difficult to treat conservatively when surgery was required, now, with advances in microsurgery, it has brought a new quality of treatment.

“The biggest advantage of this method is to connect, restore and protect damaged body parts. For large defects in the maxillofacial area, using local flaps is not enough to cover the defects, sometimes when taking local flaps, it will cause deformation at the flap location.

Therefore, for cases with large defects, the most optimal method is to bring flaps with a tail stem from a distance to the defect, the plastic surgeon uses a microscope and microsurgical techniques to connect blood vessels to re-establish blood supply to the skin flap," Dr. Tan shared.

With this method in treating large and complex facial injuries for patients, it seems that the difficulty is "concentrated" on the surgeon. This is a difficult technique, requiring a team of highly qualified surgeons, who must be highly focused and almost absolutely precise during surgery because microsurgeries often last from 8-10 hours, and can even be up to nearly 20 hours.

In microsurgery, surgeons use specialized microscopes combined with high-precision medical instruments to repair and preserve the smallest structures in the body. They bring flaps from a distance with vascular pedicles to the defect area, then use microsurgery techniques to connect blood vessels (arteries, veins), nerves... with a diameter of only a few mm, helping to restore those defects with flaps from a distance for the patient.

Dr. Tan emphasized that in cases of patients with maxillofacial cancer, microsurgery is considered the “gold standard” for treating cancer patients. In surgery, completely removing and preventing the growth of cancerous tumors is very important to ensure the patient’s life. However, when completely removing the tumor, it will leave a large facial defect, and furthermore, it will affect the patient’s ability to eat, speak, breathe and look good.

In the past, cases such as large tumors/maxillofacial cancer would cause many difficulties for doctors during the treatment process because most patients were in the late stages when the disease was discovered, the tumor had grown large, destroyed many areas of tissue, metastasized far away... and could not be operated on. Now, with microsurgery techniques, doctors can reconstruct organs and parts in one surgery using free tissue flaps.

Many cases received free surgery at the program.

Currently, this is considered a highly accurate method, bringing many benefits in terms of results and recovery for many patients. This technique helps to minimize damage to surrounding tissues, while improving the accuracy of the repair, so patients will have a faster recovery time and reduce post-operative complications.

“Performing complex repairs on very small structures is a prerequisite for E Hospital to perform organ transplants at the Hospital in the future,” Dr. Tan said.

Source: https://nhandan.vn/hieu-qua-cua-tao-hinh-vi-phau-trong-dieu-tri-ton-thuong-lon-phuc-tap-vung-mat-post845676.html