A BEAUTIFUL STEAKING PLATE of rigatoni with sauce. For young Joan Cuc, 20, this was the real test of his brand new jaw. His mother brought it to him in a basket at the San Camillo Forlanini Hospital in Rome, where he has been back and forth with his delicacies for weeks. At the fork test, the jaw brand new that the doctors and clinical engineers of the Roman hospital gave to Joan did not simply do her duty. “But it has exceeded our most enthusiastic expectations,” he says Bruno Pesucci, director of the UOC of Maxillofacial Surgery of the San Camillo-Forlanini Hospital in Rome, a real luminary in the field of reconstructive oncological surgery. It is in fact Pesucci, 66, born in Milan, but transplanted to Rome for almost 40 years, who carried out the first intervention in the world with his team. complete replacement of a mandible. Until now, only partial replacements had been made. “When we started studying and designing the prosthesis and surgery we had no idea what the final result would be. In the literature – he continues – no work similar to ours has been documented. No one before us had gone beyond partial reconstructions. “. In this case, the courage of the doctors and the young patient paid off. Today Joan can finally have a “normal” life, without giving up her favorite dishes and without having to endure excruciating pain while chatting with others.
A face tumor
Until a few months ago, however, the boy of Romanian origin, but of Italian adoption for many years now, lived with a “monster” on his face. Precisely one fibrous dysplasia. It is considered a tumor benign, but that of “benign” has very little. “This neoplasm – explains Pesucci – is very aggressive, it affects the bones which over time are invaded by fibrous tissue”. Joan’s journey has been long. “The first time I visited him was in 2015, when the tumor had not yet reached too debilitating dimensions,” says Pesucci. “We started doing small resections, hoping to stop the disease from growing. But – he continues – this was not the case and so we began to think about more complex solutions ”. Hence the idea of trying what no one has ever done before: a complete replacement of the jaw with a prosthesis.
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Engineers at work
“Thanks to the work of our engineers – reports Pesucci – it was possible to design a perfect ‘copy’ of the patient’s mandible in titanium. A sophisticated software allowed us to design it tailored to the young patient and with the 3D printer we were able to ‘bring it to life’ “. But that’s not all. “On this prosthesis – explains the surgeon – we have created specific accommodations where we performed a bone transplant taken from the fibula of the same patient”. The hardest part was creating a muscular and joint system to make that rigid prosthesis fully functional. “We isolated the muscles – explains Pesucci – and we connected the muscle fibers with the prosthesis”. A painstaking procedure, but in the end it paid off.
The full-lore intervention
“On February 25th, together with the Plastic Surgery Unit led by Nicola Felici, we performed the surgery”, says Pesucci. “The patient was then hospitalized – he continues – in intensive care where the first more complicated weeks passed”. Many doubts and fears. The same as before crossing any new frontier. “We didn’t know what to expect exactly,” admits Pesucci. But a little less than a month later, despite the doctors’ enormous caution, it began to become clear that the surgery was successful. A great success, beyond all expectations. Unlike her doctors, Joan never seems to have doubted what the end result would be. “He and his parents trusted and trusted us right from the start”, Pesucci emphasizes. And now the Cuc family is deeply grateful to the doctors and delighted with the courageous choice made. “Mrs. Cuc – says the surgeon – comes to see me every other day, when she brings meals to her son and always continues to thank me. He is happy that his son’s nightmare, which was also his, is finally over ”.
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However, Juan’s “rebirth” work is not finished yet. In 4-5 months the young patient will undergo 4-5 implants that will allow him to have completely new teeth with which to taste his mother’s delicious dishes. In short, the icing on the cake is missing. How long his new jaw will last is hard to say as there is no precedent. “Maybe 10 or 20 years or a lifetime, we don’t know”, says Pesucci who has already thought of every eventuality, even the negative one. “For this reason, the two heads of the mandibular condyle that we have designed are ‘unscrewable’ and, in the event of wear of the prosthesis, we can easily replace it with a new one,” says the surgeon. A remote possibility, considering that titanium hardly wears out.
Now the doctors and engineers involved in the enterprise are putting their work on paper, which will soon be published in a scientific journal and which perhaps will serve to give a new life to those who have problems similar to Joan’s.
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