The journey of a man from Timor-Leste

Danial Norjidi

The Maxillofacial, Facial Plastic and Reconstructive Surgery Centre (MFPRSC) of the Pantai Jerudong Specialist Centre (PJSC) recently added another feather to its cap with the successful completion of a significant surgery that involved a jaw resection and reconstruction for an international patient.

A team of surgeons, doctors, anaesthetists, nurses and allied health professionals including maxillofacial technologists were among those involved in the milestone operation on September 13, which took 18 hours to complete.

One of the surgeons involved was Associate Specialist of Maxillofacial, Facial Plastic and Reconstructive Surgery Dr Haji Mazrul Adimin bin Haji Awang Besar, who spoke with the Weekend Bulletin about the case and the procedure involved.

The patient, who is from Timor-Leste, was referred to MFPRSC by a hospital in Malaysia. The patient was diagnosed with a large tumour of the jaw called Ameloblastoma. While it was benign, it was destructive locally and was destroying the jaw, leaving a large hole.

Dr Haji Mazrul shared that the tumour was around 10cm in length. “When he came here, the patient’s lower jaw was huge. You could see it was not normal. Even from inside the mouth you could see it was expanding the jaw.” The centre has received international patients before and they have seen similar cases in Brunei. However, this particular case was notable. “This is the first time we assisted a foreign patient with a tumour of that size.”

ABOVE & BELOW: Associate Specialist of Maxillofacial, Facial Plastic and Reconstructive Surgery Dr Haji Mazrul Adimin bin Haji Awang Besar; and Jenidio Guterres Da Costa from Timor-Leste

Principal Maxillofacial Technologist/Administrator Haji Kamaruddin bin Haji Abdullah shows the equipment for making 3D model and printing. PHOTOS: BAHYIAH BAKIR
The 3D model of the patient’s jaw

Before the operation, the team had to plan the surgery, to determine what had to be removed and how much would be lost from the jaw. The intricate nature of the operation displays both the high level of technology and expertise at the MFPRSC.

Dr Haji Mazrul highlighted that the centre, “is unique because we have everything in one building. This includes facilities for outpatients, clinics, surgery, as well as 3D modelling and printing”.

The team did X-rays, CT and MRI scans before the surgery. From the data collected, the centre’s maxillofacial technologists, with the expertise of Principal Maxillofacial Technologist/Administrator Haji Kamaruddin bin Haji Abdullah, were able to make a model of the skull, which allowed the team to determine the exact size of the tumour and plan the operation.

The jaw had to be removed and replaced with a mandibular titanium tray.

“This tray was fixed to the remaining bone of the lower jaw,” added Dr Haji Mazrul. Bone was then taken from the patient’s leg and put on the tray.

As Dr Haji Mazrul explained, “It is a fibula free flap, which means it contains bone, soft tissue, skin and some muscle.

“There was a hole inside the mouth and we had to cover that. The bone was then replaced with bone from the leg.

It has not affected the function of his leg. He can still play football or any sport and run as normal.”

He highlighted that the procedure required good coordination and communication with other specialties. It included a resection and then reconstructive surgery.

“We took the tumour out first and then did the reconstruction,” he added.

The operation went successfully. “After the operation, the patient had to be admitted under observation. Follow-up was done every day for the first two weeks and then every two to three days.

“So far there have been no complications,” said Dr Haji Mazrul.

“In the first few weeks, he was in bed, then the next two weeks, he started to walk, then all the wounds started to heal. Everything started to shape.

“The swelling is already gone. Everything is going well, as planned,” he added. During the tumour removal, some teeth were lost, because the jaw itself was removed. “The bone from the leg that was put there has two purposes – to shape as well as to hold implants.

“In the future, once the patient has fully recovered, dental implants will be put onto the bone to replace the teeth,” he explained further.

The implant can be done in Brunei as there are two local dental implantologists at the centre, both Harvard graduates.

The patient, Jenidio Guterres Da Costa spoke to the Weekend Bulletin and was full of praise for the team behind the operation and his care. Guterres said that he is very happy with the level of service he received. “Service has been good from the time I started the treatment till now. The people at the hospital are all so friendly and nice.”

He feels much better now and is grateful to everyone involved in his care. Sharing his impression of Brunei, he added, “This is my first time here. Brunei is a great place, and very clean. The doctors are all very nice.

“If you compare to other countries, the medical level here is extremely professional and advanced.” The state-of-the-art MFPRSC, located at Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, commenced operations in June 2016. Dr Haji Mazrul highlighted that the centre is the only one of its kind in the region, and is something Brunei can be proud of.

“We used to send the making of trays to Singapore or Malaysia before. “Now we have all the equipment, all the machines, then we can do it ourselves. Maxillofacial technologists, I can say, are probably one of a kind in the region. They are unique in that they are very well trained in 3D printing and making all these prostheses for the tumour resection.”

He said international patients opting to come to MFPRSC for treatment are significant milestones for the centre and the nation as it showcases the capabilities its medical technology and people.