Surgeons in Italy have carried out the world’s first ever whole jaw transplant.
In an 11-hour operation at Rome’s Regina Elena Hospital, an 80-year-old man suffering from a cancerous tumour of the mouth received the new bone from a donor half his age.
Membrane was taken from the patient’s own arm to envelope the new jaw bone and to substitute the gums of the mouth.
There are as many as 3,000 cases of cancer of the mouth in Italy each year - the majority of which are caused by smoking - and in 15% of cases the tumor is too diffuse to be removed by traditional invasive surgery.
Usually such cases require amputation of the jaw, with problematic reconstructive surgery utilising metal plaques.
But these are often susceptible to rejection by the recipient.
Another reconstruction method involves transferring bone from the patient’s own limbs.
But these bone transfers can often prove unsuitable for replicating the specific movements of the jaw, especially when it involves rebuilding the curved frontal section of the bone.
The team at the Regina Elena hospital, led by surgeon Professor Giuseppe Spriano, have for the past six months been pioneering a procedure for removing tumourous jaw bones, treating them with liquid nitrogen to rid them of the tumorous cells, sterilising them and then re-inserting the jaw into the patient.
But in this case Professor Spriano, internationally renowned in his field, judged the tumour to be so diffuse as to make reconstruction of the jaw impossible.
Instead, they opted for the ground-breaking whole-transplant surgery.
The donor was a 39-year-old man who died of a brain haemorrhage two weeks before Christmas at Cesena on Italy’s east coast.
The bone was transported to the national ‘bone bank’ at the Rizzoli Orthopaedic Institute in Bologna where it underwent radiotherapy and was conserved at -196 degrees C to render it sterile and reduce the chances of rejection.
A regional transplant co-ordination network matched the jaw to the shape of the face of the patient in Rome.
Doctors at the Rizzoli hospital stressed that they also took great care not to ruin the face of the donor, substituting the removed bone with a wax mould, and avoiding making any surface cuts to the deceased’s face.
Professor Spriano said: “If this new transplant procedure utilising real jaw bones - chosen for similarity from a bank of frozen donations - proves a success there will be clear advantages for the patient, with better aesthetic, and consequently psychological, results.”
The current patient is said to be doing well. But Professor Spriano said: “It is still too early to say that the new bone will live.
“We will need to monitor the patient for a couple of years, and will continue replicating the same procedure to confirm the results.”
Dr Richard Sullivan, Cancer Research UK’s head of clinical programmes, said: “Facial deformity as a result of cancer surgery has major implications for patients’ quality of life in terms of function (chewing, talking, etc) and state of mind.
“Specialist reconstructions are an essential part of treatment and this innovative approach has great potential.
“But often the limiting factor with such cutting edge surgical advances is the ability to train other surgeons and roll-out the programme to further centres.”
Revision date: June 21, 2011
Last revised: by Sebastian Scheller, MD, ScD