Da Nang Mission, June 2018

36 patients were assessed by the 2018 FTW team in collaboration with the Da Nang General Hospital doctors, and the week’s operating schedule was planned. The UK team was made up of representatives of the following specialities: General Surgery, Paediatric Anaesthesiology, Ophthalmic & Oculoplastic Surgery, Plastic Surgery, and Theatre Nursing. Patients were selected on the basis of the training and support levels required by the local team.

Cases included:

  • nasal reconstruction
  • craniofacial microsomia
  • extensive congenital facial naevi
  • juvenile hyaline fibromatosis
  • eyelid grafting
  • ptosis (droopy eyelid) correction
  • burn scar release

In collaboration with local surgeons, FTW operated on 12 patients over the four days. These cases included soft tissue reconstruction of facial asymmetry in craniofacial microsomia, a condition usually involving reduced volume of one side of the face including the external ear, cheek, jaws and mouth.

Extensive pigmented naevi are large pigmented areas of the skin and underlying tissues that are often in visible areas of the face and neck and have a dramatic appearance. The team of surgeons managed these cases with a combination of tissue expanders as a first stage, and, as a second stage, skin flaps to cover the areas when removed.

Juvenile hyaline fibromatosis is a rare condition in which children develop painful lumps under the skin and around the joints leading to contractures (permanent shortening). They also suffer from overgrowth of the gums. Administering a general anaesthetic in these children can be very challenging as they have short stature and limited mobility, and this case was managed by a combination of the local and visiting anaesthesiologists to successfully facilitate safe surgery.

The ophthalmic and oculoplastic team worked with the local surgeons on congenital ptosis cases, a condition where the upper eyelid does not fully open, and vision can be affected if not treated with specialist oculoplastic techniques.

Burns scar release was performed in the neck area and around the mouth and eyelids using skin grafts and skin flaps.

Reconstructions of each case were used as teaching examples, and patients from previous years were reviewed with the same teaching aims.

MRI and CT scans were provided by the hospital and sent to specialist radiologists in the UK for review and immediate reporting, so that these were discussed and also used for teaching.

The week was considered a great success by all the medics involved.

Hanoi Mission, May 2018

105 patients were initially assessed by the multidisciplinary team of consultant surgeons brought by the Facing the World charity.

In all, there were 12 doctors representing the following specialities:

Craniofacial Surgery, Neurosurgery, ENT Surgery, Maxillofacial Surgery, Oculoplastic Surgery and Anaesthesia.

Treatment plans were put in place in cooperation with the local Vietnamese surgeons, and it was decided to operate on 47 of the patients jointly during the week. The teams operated at two hospitals – Viet Duc University Hospital and Hong Ngoc Hospital.

The majority of operations were performed on children, some requiring complex surgery reconstructing the entire bony anatomy of their face and skull. One of the young boys we were looking after was suffering from a condition called neurofibromatosis. He needed removal of a mass that was slowly invading his eye socket, damaging his eye and threatening his brain. 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. His left eye had to be removed but the team were able to excise the whole tumour and used bone from his skull to reconstruct his eye socket. This very challenging operation was achieved thanks to the combined work of craniofacial reconstructive surgeons, neurosurgeons and oculoplastic surgeons.

Cranial vault expansion was performed on two babies with craniosynostosis, a condition in which some bones of the skull are fused together and cause increasing pressure on the developing brain. This surgery is essential to allow a normal development of the brain. It requires the combined input from craniofacial surgeons and neurosurgeons as it involves opening up the skull to gain direct access to the brain. The surgeons removed strips of bone to create artificial openings in the skull, which will allow it to expand normally as the babies grow.

Numerous complex resections of tumours were successfully undertaken. These included cancers of the tongue, parotid gland, and other neck masses.

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 reconstructive surgeons undertook two nose reconstructions with a forehead flap, in which part of the forehead was used to recreate the defect from the nose. It is a multiple-step procedure, and in a couple of weeks the local team will complete the surgery.

Some of the nose reconstructions also involved taking some cartilage from other areas of the body such as ear or ribs. The cartilage was then sculpted to the right shape and inserted into the nose in order to make the new side symmetrical to the other.

Droopy eyelids, known as ptosis, can cause irreversible vision loss in babies if their eyes are not exposed to light for a prolonged period, and the brain is not allowed to develop normally. Early surgery is essential to preserve vision. Different procedures to help suspend eyelids were taught by our oculoplastic surgeon who operated on many children during the week.

Some of the children also suffered from narrow mouths and palates, or conditions resulting in their top and lower teeth not lining up correctly, which prevents them from eating and breathing normally. The maxillofacial surgeons successfully performed surgeries which involved cutting and reshaping the bony structures of the mouth and face, in order to not only improve aesthetics, but also dramatically improve the function of these patients.

The mission’s purpose is 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:

Congenital abnormalities including:

  • Apert syndrome (craniosynostosis, palatal deformities)
  • Congenital ptosis
  • Neurofibromatosis
  • Haemangiomas

As well as acquired diseases such as:

  • Parotid tumours
  • Nerve tumours
  • Traumatic injuries to the face
  • Contracted burns scars

The operations we performed to try and improve these problems included:

  • Cranial bone grafts for orbital reconstruction
  • Calvarial remodelling/cranial vault expansion
  • Palatal expansions
  • Le Fort osteotomies
  • Enucleation of an eye
  • Eyelid scar revisions
  • Ptosis surgeries (brow suspension, levator resection)
  • Nasal reconstructions including forehead flaps, rib grafts, ear grafts

To further complement the surgical training, each day also had an element of lecture or tutorial teaching from each member 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.

Three more missions are currently in planning for June, October and November 2018.

CEO and Trustee of Facing The World, Katrin Kandel has travelled to Vietnam this month to raise donations for the charity. Viet Nam News caught up with Ms Kandel READ MORE

Hanoi Maxillofacial Mission, September 2017

For the first time, Facing the World brought a small team of Consultants from the UK to Vietnam representing all aspects of Maxillofacial surgery, with the aim of holding a week of concentrated teaching and operating focused on one speciality.READ MORE


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