Hanoi Mission, April 2017
120 patients were initially assessed by the multidisciplinary team of consultant surgeons brought by the Facing the World charity. In all, there were 17 doctors representing the following specialities: Neurosurgery, ENT, Maxillofacial Surgery, Ocular Surgery, Craniofacial Surgery, Anaesthesiology.
Treatment plans were put in place with the local Vietnamese surgeons. It was decided to operate on 32 of the patients jointly during the week. The teams operated at two hospitals – Viet Duc University Hospital and Hong Ngoc Hospital.
The vast majority of operations were performed on children, some requiring very complicated surgery reconstructing the entire bony anatomy of their face and skull. Two of these cases were box osteotomies and calvarial remodelling. This involved accessing the upper part of the face using a bicoronal incision (ear to ear across the top of the head) and lowering all the soft tissue down to the level of the nose. Then each of the orbits (the bones around the eyes) were cut out from the rest of the skull, repositioned and held in place with plates and screws. This dramatically restructures the faces and results in a symmetrical normal appearance.
Another similar operation was a calvarial remodelling on a child with craniosynostosis, which effectively means the reshaping of an abnormally developing skull to allow the brain to grow and develop as normally as possible. This involved similar steps to those above, but without the repositioning of the orbits, and again took a whole day of surgery, requiring input from craniofacial and neurosurgery specialists. This sort of surgery can have fantastic results, but requires extreme planning and caution as it involves opening up the cranium to the brain directly.
Other shorter procedures were carried out, all equally complicated even if less time-consuming, and all life-changing in terms of the final outward appearance. For example, the consultants undertook an alar reconstruction This involved rebuilding the side of a patient’s nose by taking some cartilage out of the ear, and fashioning it to re-create the nostril, so that it matched the other side. Again symmetry was obtained.
Functional issues were also dealt with, and numerous complicated resectionings of tumours were successfully undertaken. These included tumours of the tongue, parotid gland, and other neck masses.
A young boy needed a burn scar resected to allow him to move his head and neck properly. This was achieved by taking all the tension out of the contracted scar tissue by a method known as Z-plasty, a specialised procedure which restores length to contracted tissue, thereby restoring movement.
Children’s vision was improved by carrying out procedures in which some of the fascia in the scalp is removed and then used to help suspend upper eyelids higher to rectify the dramatic problems caused by low droopy eyelids.
The mission’s purpose is to treat patients whose conditions are so complicated they otherwise would not receive treatment. The mission is also intended to build on the teaching and collaboration achieved during the year through the Fellowships offered to the Vietnamese doctors in the UK. All operations were carried out jointly by teams made up of the UK Consultants and the Vietnamese doctors.
The following conditions were treated during the week:
Congential abnormalities including:
– Craniosynostosis
– Congenital ptosis
– Neurofibromatosis
– Cleft lips and palates
– Haemangiomas
– Congenital naevi
As well as acquired diseases such as:
– Parotid tumours
– Tongue tumours
– Traumatic injuries to the face
– Contracted burns scars
The operations we performed to try and improve these problems included:
– Box osteotomies with implants
– Calvarial remodelling
– Naevus excisions
– Flap reconstructions of the nose including a chondrocutaneous graft
– Rhinoplasties with rib grafts
– Eyelid scar revisions
– Eyelid suspensions using temporalis fascia
– Z-plasty scar revision for burns
To further complement the surgical training, each day also had an element of lecture or tutorial teaching from one of the team. These sessions were held at both hospitals, and involved anatomy and surgery of the neck, using plates and screws in the face and skull (with hands-on practice on models) as well as anaesthetic techniques and monitoring.
“In Vietnamese fairy tales, there is a character called “Bụt” who will appear and help when someone needs miracle. During this week working as a volunteer, watching doctors worked as a team in operating room, seeing the change on patients, feeling the emotion of their family members, I believe that “Bụt” is not fictitious and you are all “Bụt” in real life.
To be honest, this week means a lot to me. It was my first time in operating room. For a medical student like me, it motivates me to improve not only my knowledge but also my English. I want to give my deep and sincere gratitude for letting me be a small part to make miracle does happen. I know that I still have lots of shortcomings but I hope you can give up and give me more opportunities to participate with you in missions in Hanoi or any places in Vietnam in the future.“