New Delhi: Hoping to get normal nose and lips, just like other children, nine-year-old twin brothers Ahmed and Shad from the Middle East came to India for the treatment of cleft lip deformities. However, the family had a little idea that their boys are not only about to get absolutely normal features in a few days but will also become part of an extraordinary medical procedure carried out by Delhi based plastic surgeon Dr Ajaya Kashyap.
The problems with cleft lip and associated nose and palate deformities are problems with breathing, speech and appearance. Ahmed and Shad were not able to breathe normally and even their speech was affected. At school, twins’ appearance also affected their confidence level and they were not able to cope normally. This surgery was not available in their country of origin (Yemen) as doctors feared chances of rejection and complications. After successful procedure and examination done two weeks ago, the twins are now leading a normal life, as surgery results are “exceptional with no rejection or complications”.
Explaining the technique, Dr Ajaya Kashyap, Medical Director, KAS Medical Centre & MedSpa, New Delhi, said, “Usually to correct the cleft lip deformity, which includes reconstruction of part of the nose and the upper lips, we need to take out the cartilage and fats from the rib bone of the patient. However, in this case, one of the boys was not healthy enough for this procedure. So, we took out bones and cartilage from one of the twins and used on both of them. This very rare procedure called Isotransplant has an extremely good success rate as the donor being identical twin made for a great genetic match for the recipient.”
As the parents have always been aware of the poor health of one of the twins, they could not believe how smoothly and efficiently Dr Kashyap not only solved the problem but also gave the best possible result. Sharing their experience, the parents told, “We came to this country hoping to receive the best possible medical care for our twins, but what we got here is beyond the best. This is the first time since the birth of our children we can see them smiling normally, talking without effort and facing the people without hesitation. The procedure, as we understand, was not simple, but we had put our trust on Dr Kashyap and he proved us right.”
As far as transplant therapy is concerned, the major challenge is rejection in case of an unrelated donor, wherein the immune system of the recipient start producing antibodies against the donor cells considering it a foreign substance. This leads to a medical emergency, sometimes within hours after surgery, sometimes months later.
“In this case, the less healthy boy needed someone else’s cartilage and fats for his facial reconstruction as he could not undergo such an extensive surgical procedure. However, in this type of transplant, we cannot use the tissue of an unrelated donor. But the boy was lucky that he had an identical twin brother, who shared his genetic composition, allowing us to use cartilage and fat from the healthier twin for both of them,” told Dr Ajaya Kashyap.
A cleft lip is a congenital defect that affects nearly 3.28 per 10,000 children worldwide. The deformity happens when during the pregnancy, the lip tissue does not join completely, leading to an opening in the upper lip. Depending upon the severity, the opening can be a small slit or it can be a large one going through the lip into the nose. In either of the cases, reconstruction surgery is the solution.
Research indicates that while the cleft lip is not a life-threatening condition for the children, the problem of obvious disfigurement of face extends to repeated infections, social stigma, and mental impairment that affect the speech, hearing, and teeth formation and leads low self-confidence.
“In an effort to give a better life to their children, parents try and get a reconstruction surgery in almost all the cases of the left lip. This is why for the surgeons it becomes even more important to give their best shot. We are extremely happy to have successfully carried out Isotransplant and helped these children achieve the desired results,” added Dr Kashyap.