30 years old Ms. Astha Mongia visited Sir Ganga Ram Hospital in February 2021 with a rare congenital fusion of the jaw joint with the skull bone because of which she was unable to open her mouth since birth. The mouth opening was so small that she was not even able to touch her tongue with hand. In last 30 years she was unable to eat solid and had difficulty in speaking. She had lost almost all her teeth due to dental infection. To make the situation even more complicated, the patient had a neuro-vascular malformation (Tumour) over the right half of the face, orbit and forehead. Also there was no vision in the right eye. It was such a complicated case that various leading hospitals in India, United Kingdom and Dubai had refused surgical solution.
According to Dr. Rajeev Ahuja, Senior Plastic Surgeon, Sir Ganga Ram Hospital,* “For such patients to open the mouth, both the condyles (ball like head of jaw joint) have to be removed. Many a times a tongue like bony extension in front of ball joint known as Coronoid Process also has to be either removed surgically or at least fractured but in her case this was easier said than done because there was bunch of vessels surrounding the Coronoid Process on the right side”.
The team for this complicated surgery was lead by Dr. Rajeev Ahuja and was assisted by Dr Raman Sharma & Dr Itishree Gupta from Plastic Surgery, Dr. Ambarish Satwik from Vascular & Endovascular Surgery and Dr. Jayashree Sood & Dr Amitabh from the Anaesthesia team. They decided to go ahead with the high risk surgery after extensive discussions and planning with radiology & vascular experts.
Three weeks before the surgery the entire surgical area was injected with a sclerosant to shrink the blood filled vessels, as far as possible. During surgery her fused temporo-mandibular joint (jaw joint) was reached after slowly pushing aside bulky neurovascular formations. At this stage, any misadventure would have led to excessive bleeding and possible death on the table. After this both the condyles which were hampering opening of the jaw were successfully resected on both the sides. We also gently dissected and teased of the bunch of vessels around the outer side of the Coronoid Process to make space for cutting the Coronoid Process, to allow mouth opening. The whole surgery done on 20 March 2021 took three and half hours (3½ Hrs). At the operation table the mouth opening of patient was 2.5 cm.
At the time of discharge on 25 March 2021, her mouth opening increased to 3 cms. A normal person has a mouth opening of 4-6 cm. Speaking clearly for the first time after 30 years, *Ms. Astha Mongia who is currently Senior Manager in Punjab National Bank said,* “It is a miracle that I am able to open my mouth as well as can eat without any difficulty. I am very happy”.
According to Dr. Rajeev Ahuja,* “Her mouth opening will further increase in the coming days by way of mouth opening exercises”.
According to Shri Hemant Pushkar Mongia father of the patient,* “We had gone to leading Indian Hospitals, as well as to United Kingdom and Dubai but she was refused surgical treatment due to high risk involved. My daughter has suffered a lot in last 30 years, her mouth opening was so small that she could not even touch her tongue by hand. Today, after successful surgery she can not only open her mouth but also touch her tongue. “
Opening her mouth after 30 years Astha Mongia said, “Thank you lord and Doctors for this second birth”.*
admin
Three weeks before the surgery the entire surgical area was injected with a sclerosant to shrink the blood filled vessels, as far as possible. During surgery her fused temporo-mandibular joint (jaw joint) was reached after slowly pushing aside bulky neurovascular formations. At this stage, any misadventure would have led to excessive bleeding and possible death on the table. After this both the condyles which were hampering opening of the jaw were successfully resected on both the sides. We also gently dissected and teased of the bunch of vessels around the outer side of the Coronoid Process to make space for cutting the Coronoid Process, to allow mouth opening. The whole surgery done on 20 March 2021 took three and half hours (3½ Hrs). At the operation table the mouth opening of patient was 2.5 cm.
