“Less than 50 reported cases exist in the world, and the procedure to give Ms Mahkge a new face – and life – was definitely the first in South Africa,” said Dr Cules van den Heever from the Department of Prosthodontics of the University of Pretoria (UP).

The team of specialists, including Dr Hermann Kluge (maxillo-facial and oral surgeon) and Dr Johan Kluge (ear, nose and throat specialist) performed the procedure on Ms Mahkge free of charge. The nasal implants and the external prosthesis were sponsored by ASM Consultants and the pre-operative models were sponsored by the Rapid Prototyping Unit at the Central University of Technology in Bloemfontein. These models were produced by a process of three dimensional printing. Mediclinic Kloof donated their facilities, including the theatre and Ms Mahkge’s stay in the critical care unit of the hospital.

The procedure, that took about six hours, was deemed a surgical success and Ms Mahkge will, if she heals well, will have a new face in about a month’s time.

MAXILLO-FACIAL SURGERY

Because of the absence of nasal passages, Ms Mahkge has had to breathe through her mouth. This means that she had to eat slowly and was prone to choking. An ostium (opening in her windpipe) was created at birth as a backup mechanism to allow her to breathe but it increased her propensity for developing upper respiratory tract infections. Furthermore, because of the absence of naso-lacrimal canals and nose, her tears could not drain through the nose but ran down her face, causing further infections. Her vision is impaired.

Saturday’s procedure included:

· The establishment of nasal pasages

· The establishment of lacrimal passages (tear ducts)

· Le Fort 1 osteotomy

· Lateral expansion of the maxilla (upper jaw)

· Anterior maxillary implant placement followed by replacement of the anterior maxillary teeth.

· Nasal prosthesis.

As nasal passages have now been created, Ms Mahkge will be able to breathe through her nose, thereby reducing her vulnerability to choking. With the ostium closed, she is less likely to suffer from upper respiratory tract infections. The chronic infection as a result of lack of tear drainage should clear up.

HISTORY

Ms Mahkge’s was first presented at the Oral and Dental Hospital of the University of Pretoria as a seven-year-old. She was mentally normal and systemically healthy, but with delayed growth and cognitive skills for her age.

She had a tracheotomy procedure at birth but no further surgical or prosthetic rehabilitation was done before her first visit to the University’s facilities.

At her first visit more than ten years ago, she was assessed by a multidisciplinary team who decided that surgical reconstruction at the time was not possible, and that the most suitable treatment option would be to fabricate an external nasal prosthesis. The Oral and Dental Hospital provided her with the prosthesis. She returned after six months with inflammation around one of the abutments. She was treated but then disappeared for 10 years.

It is understood that Ms Mahkge feared that she might lose her social grant if she underwent further treatment.

She has lost both her parents since the previous intervention and cares for her mentally disabled sister. Owing to her severe facial disfigurement her contact with other people is limited and she has not attended school. This has a severely limiting impact on the income that she was able to earn.

“The operation will improve her facial appearance and it is expected that this will have a positive impact on her ability to interact socially,” said Dr Van den Heever.

A community development worker and members of the community are supporting Ms Mahkge and her fear about the potential loss of her social grant has been addressed.

OPERATION FACE TO FACE THE WORLD

The Department of Prosthodontics of the University of Pretoria (UP) and the Gauteng Department of Health are committed to assisting people with facial deformities and established one of few centres countrywide where specialised maxillo-facial prosthodontics services are offered to state patients.

“Facial disfigurement is devastating. It has an impact on the way the person interacts with other people and how society reacts to him or her. In addition to social exclusion, these patients may experience other problems that result from the loss of facial tissue, for example difficulties with chewing and swallowing food, breathing and speech impairment,” said Dr Van den Heever.

Many of these people can be assisted by operations that reduce the extent of the deformities and improve the associated health problems. Such surgical interventions contribute to the reintegration of these patients into society. The University’s Fundraising Section is currently launching a campaign called Operation Face to Face the World to assist more patients like Ennica Mahkge.