Surgery By Bangalore Doctors Enable 29-Year Old To Open Her Mouth After 20 Years

The inability to open her mouth and survived only on liquids, 29-year-old Shenaz Khatun from Assam had been leading her life without speaking for the past 20 years. A 3D model was created and found that the lower jaw was fused into the skull and other multiple points. Through this model, the doctors practiced to ensure minimal risks before surgery. Led by Dr. Sundar Raj Ellur, Head of the Department of Plastic Surgery at Bengaluru’s St. John’s Hospital with Senior Surgeon Professor Dr. Vijay Joseph along with the team of doctors conducted an 8-hour-long surgery at St. John's Hospital on July 2nd made Shenaz open her mouth up to 5 cm.

Now the doctors are trying to improve her appearance as well. Doctors feel that the opening of her mouth and jaw appearance will be made better through an alignment jaw surgery later in a year or so. Dr. Sundar Raj said that this case was done as a part of awareness for society on the occasion of World Plastic Surgery Day on July 15th.  

Talking about the cause of the girl’s problem in a candid conversation with Lokmat representative Dr. Anubha Jain, Dr. Vijay Joseph, Professor and a senior surgeon from St. John’s Hospital who was part of the team that conducted this complex surgery said after a fall at the tender age of five Shenaz got an injury in the region and the jaw was infused. She couldn’t open her lower jaw and went for surgery in Kolkata four years later at the age of 9. But after some time, her jaw fused again. Last 20 years she has not been able to open her mouth, her jaw grew in that position. Her upper part of the face enlarged with age but the lower part couldn’t as the lower jaw is locked inside the upper jaw. Recently her visit to Bengaluru’s St. John's Hospital revealed that her lower jaw was fused to the base of her skull creating a rigid deadlock. 

A CT Scan showed that a piece of the skull or the joint that helped in the movement of the lower jaw was not there causing this restriction. So part of the brain was exposed at a certain level. A severe fall and persistent ear infection during her childhood compounded with her earlier surgery which left a hole in the base of her skull and locked her jaw made the situation so difficult for her. Dr. Vijay Joseph said that the girl’s lower jaw was firmly attached to her skull and it might have required cutting the skull with a saw to separate it and make it mobile.

Talking about the challenges and procedure of this complex surgery Dr. Vijay Joseph said, "Decayed teeth were a challenge for the team of doctors and that was the aftermath of her mouth being closed for so long. The dental team is working on the cavity part, correcting the teeth orthodontically, and saving her teeth. If require in the future, will replace it with a denture. Another challenge was to give anesthesia. A specialized anesthetic team did a Fiberoptic bronchoscopy where they passed a flexible tube through the nose to conduct the procedure and see inside the airways of the lungs. Reaching this area was another big challenge so we used the intraoral and extraoral approach. A broad chunk of bone which was attached with a multiple point to the skull but as we practised on the 3D model earlier so we were sure what needed to be done. We took off a little bit of the bone. The important thing is to prevent recurrence where we do rib cartilage. The bone graft with rib cartilage remained in the gap that we created between the skull and the native mandible. That will prevent it from reforming again.” 

Talking about Shenaz's progress Dr. Vijay Joseph said that she can eat but not a large chunk of food as it will take time for her muscles to adjust. Speaking wise she can still speak. She can speak with her mouth open. She can swallow larger portions of food which she was never able to do for the last 20 years. Once she gets comfortable with opening and closing of mouth her other speech-related issues will also be resolved but it will take time, he added.