We had a successful week at CURE Ethiopia.  The team of plastic and maxillofacial surgeons from Europe were able to operate every day that they were here.  They were able to cure five patients with large head and neck tumors. Each surgery took approximately 12 hours. All five patients are recovering well in our intensive care unit. Please pray for their continued healing.

I am going to briefly describe the surgery and show you before and after photos so that you can get an idea of what each surgery entailed.

This is Mohammed. He has an ameloblastoma involving his jaw.

Mohammed

While the surgeons were still home in Europe, they were sent CT scans (i.e., “cat” scans) of each patient so they could map out the surgeries. The surgeons spent many hours planning the resections and needed grafts for these patients before coming to Ethiopia. For example, they created metal templates in Europe and brought them to Ethiopia. These templates are used to attach the new tissue grafts to the patient’s face in order to fill-in the defect left by the removed tumor.

From an anesthesia perspective, huge tumors close to the airway make securing the airway much more complicated. Mohammed had a very limited mouth opening.  This made intubating him with an endotracheal tube, which is necessary so that he could breathe during surgery, technically challenging. We had to intubate his trachea with the breathing tube while he was awake using a special fiber-optic bronchoscope. After he was asleep, he received special IV’s and monitors. For example, we put in an arterial line, or “a-line.” A-lines are basically IVs put in an artery rather than a vein.  They are more technically challenging.

An important part of cure’s mission is to train local medical personnel.  This is the first time the CURE Ethiopia nurse anesthetists had seen an a-line.  I showed them how to perform them and then supervised them while they performed them on the rest of the patients throughout the week.  Throughout the week, the Ethiopian medical personnel at CURE received other training and experiences that are rare here (i.e., practice intubating with the fiber-optic bronchoscope, etc.).  These patients require much more attention after the surgery, so they have to be in the ICU.  Our ICU was full and put to good use this week.  The ICU experience also created an excellent training opportunity.

Mohammed with his new jaw in place.

The first part of the surgery involved resecting the tumor.  Most of his jaw had to be completely removed because the entire jaw was involved with the tumor.

Next, the surgeons remove a portion of bone (with muscle, blood vessels, and skin still attached) from the leg. They take this portion of bone and fashion it to fit the patient’s jaw template perfectly. They use chisels and screws and drills that look like a “drummel” until the jaw is an exact fit for the patient’s defect. The graft is then ready to be reconnected to arteries and veins within the patient’s face in order to give him a new jaw.

We are very thankful for the team that came and shared so much of themselves to make a new life for these patients.

How can we thank God enough for you in return for all the joy we have in the presence of our God because of you?  1 Thessalonians 3:9

Originally posted at: http://ethiopia.thebernards.org/2012/01/29/success/. Note: the original post includes medically graphic pictures.