Reproduced from The Mirror, 24th of January 2002
"When Constance was told she had cancer of the mouth she thought she would be terribly disfigured...until a leading surgeon performed his miracle"
TO LOOK at Constance Searle today you would never guess that half her face has been re-built in an astonishing 12-hour operation. Surgeon Iain Hutchison removed a slice of bone five inches long and one inch thick from her shoulder blade and crafted it into a jawbone. He then used it to replace the left hand side of Constance's cancer-ravaged face from her ear to her chin."It is absolutely brilliant," says Constance, 65, from Rainham, Essex.
"My husband George and I were obviously very scared when we discovered I had cancer, especially when we were told that to cure it the surgery would mean removing virtually half of my face. I was told very delicately but left with no illusion how serious it was. It is amazing how my face has been rebuilt so fantastically."
Constance's cancer started as an innocent-looking mouth ulcer. But when it failed to respond to medication and was still visible after two months her concerned GP Dr James Stiff referred her to Mr Hutchison at the Royal London Hospital in East London. He immediately diagnosed a fast- growing mouth cancer which had already spread over half her jaw. Within a month Constance was in the operating theatre having the cancer removed and her face rebuilt. It was a complex and intricate operation.
First Mr Hutchison, a leading consultant maxillo-facial surgeon, removed the cancer, and half of Constance's jaw. Then he took out the lymph glands in her neck to ensure the disease had not spread. Next he cut away the section from the top of her left shoulder blade with the muscles and blood vessels attached to it, making sure he preserved the shoulder joint. He also removed a slice of skin from her back to line her mouth. Then the surgeon rejoined the remaining blood vessels and muscles in the shoulder. The next step was to reshape the section of shoulder blade into the shape of a jaw which was fixed in place with a large metal plate and 28 metal screws. Then came the even more tricky job of joining the tiny blood vessels attached to the grafted bone - each one just two millimetres thick - to the carotid artery and jugular vein in the neck. "I had to be very careful not to damage the artery or the vein because it is the circulation that keeps the bone alive," says Mr Hutchison.
"It is thanks to micro-vascular surgery like this that we can now rebuild people's faces. Before the bone grafts simply died. There has been a dramatic improvement in reconstruction over the past 10 or 15 years. We can now remove huge and aggressive cancers and instead of leaving patients with a gaping hole in the side of their faces we can rebuild them."
Constance was in intensive care for 10 days and in hospital for five weeks. Her arm was strapped to her side for a month to allow the shoulder muscles to reattach but she quickly regained full use of it. She also endured five weeks of radiotherapy, and a plastic mask was made to fit over her head to ensure the beams were always aimed at the right spot.
"My whole head had to be wrapped in bandages, then plaster of Paris was spread on. When that was set it was cut off and the plastic mould made," says Constance. I had to travel to hospital every day for five weeks for the radiotherapy. My mouth and throat were very sore and I had a blistered tongue and split lip. I could only manage soups and minced food for six months after the operation." Constance needed false teeth implanted into her new jawbone and intensive speech therapy. She also required two further operations to remove the plate and screws and reduce and reshape the muscle in her new jaw. But now, four years later, it is impossible to tell by looking at her the incredible surgery she has endured.
MOUTH cancer affects the mouth, tongue and lips and strikes about 3,800 people a year in the UK. It is one of the most mutilating of cancers and destroys the patient's ability to speak and eat properly. It also kills 1,700 people a year. Smoking, chewing tobacco and heavy alcohol drinking are the major causes. Constance smoked 20 a day. Early signs are red or white patches in the mouth or ulcers that do not clear up after two weeks. "Tragically, many people ignore the signs of the cancer and don't seek treatment until it has become very advanced," says Mr Hutchison. "We want to catch this disease early so we have a greater chance of curing our patients. We also need more research so that we can develop new techniques and ensure the physical outcome is even better for patients."
The UK Oral Cancer Research Group was set up to conduct research to improve the treatment of mouth cancer and other tumours affecting the face.
It is supported financially by a new charity The Facial Surgery Research Foundation - Saving Faces.
-Donations to the Facial Surgery Research Foundation, Department of Oral Surgery, The Royal London Hospital, Whitechapel, London E1 1BB.