Face-Saving Craniofacial Operation Services To Mentally Handicapped The Battle Of Santosh
Face-Saving Craniofacial Operation
Services To Mentally Handicapped
The Battle Of Santosh
Face-Saving Craniofacial Operation
(From a report in The Times of India)
Mahesh Naik (not his real name), age 25, had developed deformities of the face, skull and eyes - a condition known in medical parlance as 'Fibrous Dysplasia'. Not only did his life become arduous, he began to suffer from severe psychological problems. As his appearance altered, he went deeper into depression and his deteriorating condition made life seem an ordeal.
After being subjected to extensive medical examinations, Naik was finally admitted to the K.G. Patel Children's hospital where Dr. Hiren Bhatt decided to perform phased corrective surgery of all his deformities. The surgical procedure, which lasted a marathon 20 hours in the first stage alone, corrected the deformities of skull and eyes (orbital hypertelorism).
As it turned out this was the first ever 'craniofacial operation' carried out in Gujarat, giving patients afflicted with fibrous dysplasia new hope.
While Naik is still undergoing orthodontic treatment, doctors say craniofacial surgery is highly efficacious in the rectification of deformities of the skull, face, eyes, jaws, etc.
An elated Dr. Hiren Bhatt said the procedure also proved effective in righting deformities of the face, lips, nose and palate persisting in operated cases of cleft upper lip (hare-lip) and palate in childhood; inability to open the mouth due to problems in the jaw joints. Conditions like retruded chin and protruding jaws that gave an abnormal look to the profile could also be corrected by this procedure.
According to the medical fraternity, craniofacial surgery - a branch of Plastic Surgery - deals with such grave deformities which induce an inferiority complex in an individual preventing him from taking active part in social activity.
"Operations of this type are very complex and our country lacks the facilities for training in this area," said a K.G. Patel Hospital spokesman. Operations in such cases necessitated a team of specialists with a plastic surgeon as co-ordinator.
Deformities of the eyes or Orbital Hypertelorism, are corrected by making an incision in the scalp. The neurosurgeon lifts the brain out of the skull following which the plastic surgeon cuts at the bony socket of the eye with specialised air-driven saws and drills.
The eye is then repositioned in its new location and fixed with tiny plates and screws or wires. For the problems of the jaw, orthodontists carry out alignment, both before and after surgery. The plastic surgeon and oral surgeon move the jaws after isolating them from surrounding bone and tissue and then adjust them into place. In most cases of this nature not a single incision is made, leaving no scope for facial scarring.
In the epoch-making operation that was completed in about 20 hours, Dr. Hiren Bhatt was assisted by neurosurgeon Dr. Monish Malhotra, oral surgeon Dr. Mohan Wakade, anaesthetist Dr. Veena, Dr. Dipti and Dr. Charu, besides other staff of the hospital.
Hospital superintendent Dr. B.C. Patel said the hospital had developed special facilities for performing craniofacial surgery and special provisions had been made for further development in the near future.
Services To Mentally Handicapped
The world is beautiful and god is great, one who created it but contradictions to this rule are many and those are called unfortunate ones. Mentally Challenged Children fall in this category.
With the development of diagnostic facilities and new methods of treatment it has become possible to render assistance to children afflicted with different impairments. This involves assessment, diagnosis and therapies.
What happened to Divesh (not his real name) is a successful outcome of such endeavour. When this child came for treatment, he had no speech, drooling, unable to walk properly and bit others. The child became a source of tension in the house.
A number of therapeutic programmes were administered on the child, such as IEP, Behaviour Modification, Physiotherapy, Occupational Therapy and Speech Therapy. Periodic evaluations were carried out to monitor the progress. In four to five months the child has responded well to the treatment. Drooling has stopped, he spoke a few words, walked without support and started interacting positively with others.
In order to provide better and wide coverage the Medical Care Centre Trust decided to open a School in 1998 for such children. It is called 'KARISHMA', so named after a child who had been a beneficiary of such a programme. The important point in the creation of this school is that since 1993 the Trust runs a Diploma Course for Special Educators, recognised and supported by The National Institute for the Mentally Handicapped, Hyderabad. Not only this, the Mental Health Clinic of the Trust provides all therapies under one roof with paediatricians to render an effective cover. The set-up is ideal for a child with handicaps.
Santosh Nag was born prematurely (in the 7th month) on 16th June, 1987. His weight at birth was 1.2 Kg. Soon after birth he had asphyxia for a second or two. He was kept in an incubator for 5 days. He had other complications like jaundice, infection, cyanosis, etc., for which appropriate treatment was given. He was admitted in the hospital for 45 days. When his weight reached 1.7 Kg. he was sent back home.
Due to asphyxia at birth all his early milestones, like turning on the sides, on to the stomach, going forward, etc., did not appear at the normal period. At the age of 10 months it was known that there was damage to the brain at birth and because of it he would lag behind in all the milestones and that he would never be normal. After consultation with the specialist in the field his parents were advised to start physiotherapy, cognitive therapy, etc., as soon as possible.
Santosh's mother was initially very reluctant to come for treatment. She was not at all co-operative but after a good deal of counselling the mother adopted a positive approach and that resulted in progress which can be seen in the child.
The first problem to be tackled was on motor development followed by therapeutic intervention in the field of mental, speech and language development.
The interventions led to development in his motor abilities to control his movements. The speech therapy made him grow from syllables to words on to the sentences. Today he can, at the age of 11 years, translate, follow and speak Hindi, Gujarati and Kannada.
Similarly his mental abilities also developed, which controlled his drooling.
There is remarkable progress in Santosh. One of the major contributory factors in this progress is a co-ordinated counselling which increased the mother's co-operation. Mental Health Clinic holds fortnightly clinical meetings in which critical aspects of such important cases are discussed amongst the therapist and the doctors.
When we look at Santosh's progress in each area, it is always a fixed programme for a prolonged period, then some improvement is observed. Perhaps this is how we are going to continue with our intervention. Whereas the goal of any therapy is termination, that is not possible with Santosh until he can be handed over to some trained person who can be in touch with us and help Santosh or until he is able to join some special school.
The team which could achieve such a remarkable feat consisted of Dr. Arun Phatak (Child Specialist - Paediatrics), Dr. Meeta Saxena (Physiotherapist), Mrs. Rashmi Shah (Speech Therapist), Mrs. Sandhya Khatri (Occupational Therapist) and Ms Rekha Das Adhikari (Play Therapist).