AIMMS docs carry out India’s first complex jaw implant

In the first such operation in India, doctors at Delhi's All-India Institute of Medical Sciences carried out a Temporomandibular Joint (TMJ) replacement surgery on a 19-year-old lad, where the fused bones of his skull and jaw were removed and replaced with a joint implant - a sort of miniature version of implants used in knee joint replacements.

After the surgery, completed in two sittings on 1 and 8 October, Shivam Sharma had his first plate of golgappas (a popular Indian street food that requires the jaws to be opened wide).

It was the first time that the Class XII student from Hisar, Haryana, could open his mouth fully since the age of 10, when he fell from his terrace while flying a kite and fractured his jaw. Like most of the 150-odd patients awaiting similar surgery at AIIMS, Shivam was basically treated for all other fractures except the serious one in his jaw.

Within weeks, he developed a condition called TMJ ankylosis or fusion of the lower jaw with the skull bone. Doctors said the condition is commonly seen in cases where jaw fractures are not immediately treated and the joint is not used for a sustained period.

''Sometimes children cannot identify a fracture. So they just stop using the joint for a while. Shivam's parents were feeding him mashed food through the gaps between his teeth, because he could not chew or swallow. He could not even speak properly. His facial structure was asymmetric because of the fusion of the skull and jaw bones. He also had breathing difficulties,'' Dr Ajoy Roychoudhury, head of oral and maxillofacial surgery at AIIMS, said.

In Shivam's case, the symptoms were worsened because the fusion was on both sides of his mouth.

''It affected my studies. It was hard making friends because I looked different. I watched so many people eat golgappas (also known as pani-puris) and felt my mouth water,'' Shivam said.

In 2012, doctors had tried to use a different surgery technique to fix Shivam's jaw, but the procedure was unsuccessful.

The new surgery was performed with special anaesthesia, using fibre-optic techniques, since Shivam could not open his mouth for a tube. Doctors said an X-ray before the surgery showed total fusion of bones.

In the surgery, the neurovascular structure of joint, including the nerves and muscular structures were removed, and the FDA-approved imported implants were surgically put.

Shivam's father Purushottam Sharma said each of the two implants cost Rs1.5 lakh. Dr Roychoudhury said more investments and attention from the government was required to bring down the costs.

According the doctors, 400-450 such surgeries had been performed in Europe and the USA since 1995, but this was the first for India.

''This is surprising because the incidence of TMJ ankylosis is much higher in Asian countries, particularly India,'' Dr Roychoudhuy said.