For those of you who missed the recent Straits Times article on our Indonesian patient, Rudolf Santoso, the story is reproduced below.

ground breaking surgerySingapore docs correct botched jaw operation

Patient disfigured and in pain after surgery in Jakarta to rid tumour

By Melissa Pang

When Mr Rudolf Santoso had his lower jaw removed because of a tumour, he did not expect to suffer more pain after the operation.

The 52-year-old Indonesian underwent surgery in Jakarta to remove a 7.5cm tumour in his lower jaw and have 70 per cent of his lower jaw removed and replaced with a titanium plate.

But it led to recurring infections for more than five months and he finally sought treatment in Singapore.

Here, in a rare instance of specialists from both the dental and medical fields working together, the team of four doctors not only fixed his botched surgical job, but also managed to more than halve the time taken to complete it.

The team included maxillofacial prosthodontist Ansgar Cheng; consultant ear, nose, throat, head and neck surgeon Andrew Loy; consultant plastic surgeon Erik Ang; and oral maxillofacial surgeon Ho Kok Sen.

All four specialists are in private practice at Mount Elizabeth Medical Centre.

Adjunct associate professor Cheng was the first to see Mr Santoso, the supervisor of an industrial estate. He assembled the team of specialists and coordinated the treatment plan for Mr Santoso.

“When doctors begin treatment on a patient, they try to have a good idea of the functional outcome. But Mr Santoso’s doctor overseas started the journey without knowing the end point,” said Prof Cheng, who also performed restorative work on the patient’s teeth.

The Indonesian had a rare condition known as ameloblastoma, a slow-growing tumour in the jaw caused by cells that normally develop into tooth enamel. While it was not life-threatening, his doctor in Jakarta recommended having it removed as the tumour would continue to grow if not addressed early.

After removing 70 per cent of his lower jaw, a poorly fitted titanium plate was inserted. It caused Mr Santoso prolongued infections and two exposed holes – one visible from his oral cavity and the other from his neck.

“There was pus coming out of the wound on my neck, and a bandage had to be placed there permanently.”

“I also had to take time off work very often to have the infection cleaned up at the doctor’s. The pain was unbearable,” said the patient, who lost more than 20kg during that period.

The infection also dramatically affected his quality of life.

He could not eat or speak properly and he was disfigured: The absence of a lower jaw made the father of two grown-up children look like a 70-year-old.

Feeling frustrated and desperate, he began seeking the opinion of other doctors in Indonesia.

On the suggestion of a friend, he emailed Specialist Dental Group, where Dr Ho and Prof Cheng work, for help.

In all, Mr Santoso paid about $130,000 for the consultation, surgery and expenses incurred from having to travel to and from Singapore several times for treatment.

The team in Singapore worked out a treatment plan which involved surgery to take bone that is not needed for walking from his left leg, and implanting it into his mouth.

After the bone graft in his mouth healed three months later, Dr Ho took over to place dental implants.

The procedure, which would ordinarily take a year to finish, was completed in just slightly over three months.

“The first operation took place in June this year, and the implants were placed in September.

He is now able to speak and eat properly, even though his entire set of lower teeth are dental implants.

Mr Santoso, who has a 48-year-old wife, also looks 95 per cent like his old self, despite doctors not knowing what he originally looked like.

He said: “My self-confidence was really affected after the treatment in Jakarta. Now I am not only able to return to normal activities, but I feel more handsome too.”

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