Rambam Surgeons Perform First Surgery of its Kind in Israel: Jaw Restoration using a Shoulder Bone
December 2, 2020 –Surgeons at Rambam Health Care Campus operated for 12 straight hours to restore the jawbone of a man who had undergone a massive resection of a large tumor. Technological innovations and a new treatment modality allowed them to use the patient’s shoulder bone and restore his hope for quality of life. About two years ago, Yossi (not his real name), a resident of Israel’s central region in his 60s, underwent surgery at a hospital near his residence to remove a large tumor in his lower jaw. Although life-saving, the surgical procedure resulted in significant disfigurement, since half of his jaw had to be removed. The complexity of the case precluded any possibility of a restorative bone graft, and as a result, Yossi was left with significant limitations that negatively impacted his quality of life. He could not eat solid food, had difficulty speaking, and had little contact with people due to the esthetic results of his surgery. Upon learning that Rambam’s Department of Otorhinolaryngology-Head and Neck Surgery might have a solution to his problem – by performing a bone graft – Yossi contacted them. Reconstruction of his jaw involved a complex 12-hour surgical procedure and the involvement of a 12-member multidisciplinary surgical team. This is the first time this specific surgery was performed in Israel, and Yossi became the second patient in the country to be treated with this specific surgical modality. The first patient was treated at Rambam several months ago, and is also doing well today. The surgeons removed a piece of bone and muscle from Yossi’s shoulder. Using a microscope, they then connected the blood vessels from the shoulder bone to the blood vessels in his neck. Using three-dimensional simulation techniques, the surgeons were able to shape the shoulder bone, with perfect accuracy, in order to match Yossi’s missing jawbone. "There is new hope for many patients who, until today, could not undergo facial reconstruction following cancer surgery," says Professor Ziv Gil, Director of Rambam’s Head and Neck Center, who headed the surgical team. "It's not just about giving the patient a dignified appearance, but also about regaining the ability to use the mouth and teeth for speaking and eating." According to Dr. Yotam Shkedy, an attending physician in the Department of Otolaryngology-Head and Neck Surgery, this is an innovation that can benefit many patients. "For years it has been customary to restore the jaw using bone from the patient’s calf," he explained. “However, this innovative technique that was brought to Rambam enables use of the shoulders and allows for complete restoration of the face and teeth." Further restoration and implantation of the teeth will be performed in the Department of Oral and Maxillofacial Surgery by attending physician Dr. Salech Nasyer, who also participated in the surgery. "The ability to accurately plan the surgery in advance is an essential tool in providing a creative solution to a problem that affects the lives of many patients," Dr. Nasyer explained. "For a person who has suffered from an esthetic and functional problem for a long time, it is of great significance that at the end of the surgical rehabilitation period, the patient can undergo a dental implant procedure and look and behave as though the resection surgery was never performed." Yossi is looking forward to the next step. "When I was referred to Rambam after discovering they had a solution for my problem, it didn’t matter to me from where they would take the bone," he recalls. "They said it was a solution with a high chance of success and I grabbed the opportunity. According to the prognosis, I should be able to function in a completely normal way, and I can’t wait." In the photo: Surgeons at Rambam treating Yossi. Photography: Rambam Health Care Campus
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