A small spot appearing on his cheek that seemed harmless has become a disease that has lasted for many years, causing Mr. N.V.L, 70 years old, in Hanoi to undergo many surgeries, radiation therapy and face the risk of serious facial deformity.
According to Dr. Duong Manh Chien, head of the Department of Plastic Surgery and Interdisciplinary Surgery, Central Tropical Diseases Hospital, the patient's initial injury was only a small spot in the cheek area. After surgery to remove it at a medical facility in Ho Chi Minh City, the tumor quickly recurred. The pathology results in the next surgery determined that this was squamous cell carcinoma - a type of skin cancer that can be invasive and relapse if not treated thoroughly.
After being diagnosed, the patient continued to undergo surgery to widen the tumor, create a shape for the missing area with a forehead patch and radiation therapy. However, the side effects of radiation therapy caused the skin around the injured area to become stiff, contracted and atrophied. Despite a stable period, the tumor continued to recur.
In recent months, the patient has continued to undergo surgery in Hanoi. However, only about two weeks after suturing the surgical wound, the wound ruptured and the lesions reappeared. After that, the patient was removed again and covered with skin grafts, but about 6 months later, this skin area became protruding and relapsed.
When admitted to the Central Tropical Diseases Hospital, the condition became very complicated. The tumor was no longer localized in the cheek area but had penetrated deeply, causing contraction of the entire surrounding soft tissue. The lower eyelid was clearly dilated, making it difficult to close the eyes, and the corner of the mouth deviated from its normal position. The skin area under radiation treatment became stiff and deformed, seriously affecting both function and appearance.
Dr. Duong Manh Chien, said that the biggest challenge of the case is not only the complete removal of the tumor but also the process of face reconstruction after surgery.
For cases of repeated recurrence, if not removed widely enough, the risk of recurrence is still very high. However, when having to remove widely in the face area - where many nerves, blood vessels and structures related to the eyes and mouth are concentrated - functional and aesthetic recovery is a very big challenge," Dr. Duong Manh Chien said.
During the surgery, doctors removed the entire injured area. Because the tumor was deeply ingrained, the team was forced to cut off a part of the bite muscle and remove the encroached cheekbone. After removal, the missing area on the face was very large, revealing the bone below.
To restore the patient's face, doctors simultaneously perform many complex reconstructive techniques. The lower eyelid is corrected to close again, the corner of the mouth is brought closer to the normal anatomical location. A free skin patch is taken from the thigh area to cover the entire missing area on the face. The blood vessel system that nourishes the skin patch is also microneedled to ensure that the graft survives well after surgery.
After surgery, patients can close their eyes again, and the face is significantly improved in both function and aesthetics. The regenerated skin area has a thickness relatively suitable for the surrounding tissues, helping to restore a more natural appearance.
