Many of our readers may remember the little girl whose dream of meeting her favourite actor was realised thanks to the Make-a-wish Foundation, Bangalore. We share with you the journey of 9-year-old, Sakshi, who is undergoing treatment for bone cancer.
In the early months of 2023, Sakshi’s parents started noticing a swelling on her face that seemed to be growing in size. However, Sakshi did not experience any pain. When the swelling did not subside and continued to grow over 2 months, her parents took her to a private clinic where she was evaluated and underwent an MRI. Suspecting it to be a malignancy, her doctors referred her to our hospital. At Shankara, she was evaluated and underwent a biopsy of the swelling and was diagnosed with Ewing sarcoma - a non-metastatic Osteogenic sarcoma of the right Maxilla (a type of bone cancer of the upper jaw bone).
After discussion at our multidisciplinary tumour board, it was decided that Sakshi would undergo neoadjuvant therapy and orbital plate-preserving maxillectomy. The initial chemotherapy will shrink the tumour size, followed by surgery and reconstruction. After recovery from the surgery, her chemotherapy regimen will be completed. While her parents were worried about disfigurement, hair loss, long-term impact and finances, Sakshi’s only concern was that she would have to miss her school, she was instantly relieved when she got to know that she could attend school through our School-Away-From-School facility within the hospital premises where professional teachers conduct classes for our paediatric patients. Her parents’ concerns were also addressed during counselling and Sri Shankara Cancer Foundation provided financial support for her treatment.
After 4 cycles of chemotherapy, the scans showed that the tumour had responded well to chemotherapy and reduced in size; the surgical team began planning the surgery to remove the tumour and simultaneously reconstruct the removed structures to maintain minimal defect. This extensive resection of the jaw required reconstruction to ensure a healed, stable wound and to separate the oral cavity from the sinonasal cavity.
Resecting the tumour will result in post-resection defects affecting both the function and appearance of the child’s jaw. It is particularly challenging for children because they are physically, emotionally and functionally different from adults.
The reconstruction will restore the function of the jaw with the proper internal lining to prevent future issues with chewing, swallowing, and nasal airway patency, which is vital for proper respiration. The reconstruction will also support their psychological well-being, as facial deformities can lead to feelings of social isolation.
In Sakshi’s case, the team opted for an anterolateral thigh flap, taken from the lateral part of the thigh. This choice was made to hide the scar within the thigh, keeping it out of view. The flap, a pure perforator-based free flap, involved microvascular surgery.
During the reconstruction procedure piece of tissue was taken from the thigh along with its blood vessels, dividing the vessels in the thigh, and transplanting the tissue into the mouth to form the new maxilla. To keep the tissue alive, the blood vessels in the tissues from the thigh were connected to those in the neck using a high-magnification microscope, a procedure known as microvascular surgery. Pediatric Microvascular Reconstruction concentrates on functional and cosmetic improvement without hampering the child's normal growth.
These complex surgeries are challenging but rewarding, as they help patients like our girl, Sakshi, regain confidence. Our team of head and neck onco-surgeons, along with the plastic surgeon, performed the surgery, successfully removing the tumour from the upper jaw bone and reconstructing the area.
The post-operative outcome was not only satisfying for us but also brought happiness to the entire family as Sakshi can now confidently reintegrate into society after completing her chemotherapy.
The story of Sakshi highlights the importance of timely diagnoses and is an example of how holistic care, comfortable stay, nutritious food and child-friendly wards augment the healing process.
Our Expert Teams
Head & Neck Oncology
- Dr. Sudah Sah, Dental Specialist, Head & Neck Oncology, Shankara Cancer Hospitals, Bangalore
- Dr. Karthik N. Rao, HoD & Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bangalore
- Dr. Sreeram M. P., Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bangalore
- Dr. Girish Rao, Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bangalore
- Dr. Sainath J. V., Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bangalore
- Dr. Nanjundappa, Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bangalore
- Dr. Subramanya Rao, Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bangalore
- Dr. Ghanashyam Mandal, Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bhubaneswar
- Dr. Mahesh Sultania, HoD & Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bhubaneswar
- Dr. Vaibhav Singh, Consultant, Head & Neck Oncology, Shankara Cancer Hospitals, Bhubaneswar
Paediatric Oncology
- Dr. Aarthi N., Associate Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Anand K. C., HoD & Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Raghunath B. V., Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Ramesh S., Junior Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Ramita Bhat, Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Ravneet Chhabra, Visiting Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Santosh O. S., Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Shashank Bhojaraja, Associate Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Vinu Priya D., Visiting Consultant, Paediatric Oncology & BMT, Shankara Cancer Hospitals, Bangalore
- Dr. Nirmalya Deo Pradhan, Consultant, Paediatric Oncology, Shankara Cancer Hospitals, Bhubaneswar
