"May you continue to be blessed with discernment in the tough choices you must make, and a bounty of strength for the days ahead! We love you guys, your ministry, and those you serve." JERRY & JAN FITZSIMONS

Tumors

Each time we screen patients we see patients, young and old, with swollen faces and sometimes advanced tumors. Anxious, they come not only from Ho Chi Minh City but also Provinces nearby and sometimes the Central Highlands. The origin of the swelling may be an inflammatory response, sudden or chronic infections, or a variety of benign or malignant tumors.

If the swelling is from a soft tissue or bony infection (osteomyelitis), we may opt to do surgery to remove directly as much of the infection as possible. The patients may need longer-term IV or oral antibiotic treatments, which we offer as our antibiotic supplies are available.

The malignant tumors may originate from cancers from the skin, such as squamous cell cancer. The patients may have already had these tumors removed and had radiation treatments. They may have also had skin or muscle flaps over the removal sites, in hopes of having the cancer completely gone and being able to move on in their lives.

But these swellings and tumors, malignant or benign, can be aggressive and recur. Cysts (fluid-filled swellings) and angiomas (benign tumors derived from cells of the vascular or lymphatic vessel walls), are fairly common and need to be removed as they (re)appear, if they can be done so safely. There also are chondromas, or tumors arising from muscle. And some of these tumors are ossifying (abnormally form bone from within the tumor) or fibrous (from soft tissue fibers).

The patients may present with pathologic fractures (jaws that are weakened and brittle by the tumor and radiation, breaking suddenly) or areas of skin breakdown that have become sites for fistulas (channeling secondary infections). These cases are especially difficult because the patients are weak and weary, tending to have more complex needs. We may or may not be able to help them. If not, they tend to be transferred to a cancer specialty hospital, mostly for palliative care. We are always sad when this option is their final option.

By far, the most common aggressive benign tumors we see in children and adults are ameloblastomas. They originate in the mandible (lower jaw) in the area of the teeth. Worldwide, they are rare and clinicians may never see one case in their lifetimes.

But in this region we see several every time we do our screenings. They are devastating tumors, maybe initially requiring that part of the mandible be removed, even in young children. But they are "watch and wait" types of tumors, often reappearing. Then more dramatic approaches - hemi-mandibulectomies (half) or mandibulectomies (all) - removal of half or all of the mandible are demanded.

Sometimes no reconstructions can be done. Sometimes a simultaneous mandibular reconstruction is done using hip or rib bone grafts in combination with placing customized titanium mandibular bone plates.

None of these options are easy for the patients to endure, nor for the surgeons to do. But they become the only options. These operations are involved and lengthy, sometimes requiring an entire day to complete each surgery.

Facial Syndromes

We continue to see a variety of rare facial syndromes, congenital (from birth) or as the patients go through their lives. We see unexplained hemi-facial (one side of the face) atrophy and paralysis. We can only speculate, but the atrophy may be from a condition that develops over years called Parry-Romberg Syndrome (woman in photo). One side of the face functions normally with good animation, while the other side of the face withers and stiffens. And the one-sided facial paralysis may be caused by viruses, as some think, in the case of the Bell's Palsy (man in photo). This condition may be permanent or may heal to near-normal function over time.

Trauma

Trauma always needs to be addressed when we are in Vietnam. Its causes can be many, intentional or accidental, but mostly from motor vehicle accidents, namely motorcycles.

In the case of motorcycle accidents, the greatest number of victims are young men badly wounded (despite helmets) in the streets of Saigon. When we walk through the post-operative wards we note more beds dedicated to males (has been 70% males, 30% females in recent years). And we see a few young children milling about who themselves may have their own abrasions or black eyes.

Another incidence of note is that this craniofacial, eye, torso, and limb trauma tends to happen on the left side. One can speculate that the victims experience head-on accidents on the very crowded streets, or being swiped from the left side and veering right. We are not sure of all the physics involved, only that the trauma tends to be left-sided.

Face the Challenge (FTC) was founded by Randolph (Randy) C. Robinson, MD, DDS, cranio-maxillo-facial surgeon, and his wife, Ginger Holmes Robinson, BSN, RN (cardiac and critical care). Since the late 1970's, they shared a dream to offer their medical services to the world's needy.
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