When Dr. Lam Hoai Phuong, Director of the National Hospital of Odontostomatology (NHOS) in District 5, picked us up at Tan Son Nhat Airport she told us that four-year-old Lanh awaited our team. Dr. Phuong described Lanh as having "two jaws", but we were not sure what we would actually see.
Her young father held her while the team examined her. She was quiet and cooperative. The father described Lanh as being born two months prematurely when her mother was 28 years old. Lanh remained an only child. She battled pneumonia as often as monthly, requiring nearly constant antibiotic therapy, and she could only sleep on her left side.
The family lived in Long An Province, 25 kilometers from Ho Chi Minh City's District 1. This province has increased in industrialization since 2002, especially in food processing, shoe manufacturing, and in production of plastics. Also the large rivers have been dredged in recent years, redistributing massive amounts of river mud to accommodate larger cargo boat traffic.
We encountered three patients with facial clefts during this trip, two from Long An Province; Lanh and a four-year-boy (Tessier #4 bilateral facial clefts) we also screened at the OMFH. Some refer to Lanh's presentation as a "lateral facial cleft", "neurocristopathy", or "distoma" (two mouths). Online medical case reports cited, for example, a girl with maxillary duplication in Indonesia living in an area "high in pollutants" and another girl in China with similar living circumstances. We do not know why Lanh developed this severe deformity, only that it has been reported in medical literature in recent decades.
In Lanh's case -- a lateral cleft -- presented with a duplicate right maxilla, or upper jaw. She had an extra set of upper teeth and an extra tongue. Her right eye was thus canted upward to accommodate the extra jaw. It gave the observers the sensation of always needing to adjust our own gazes into her little face. And she had a characteristic deep-set dimple that existed on the right side of her face; seen in other cases of maxillary duplication as well.
Her father accompanied her to the pre-operative holding area where she handled a 1000 Vietnamese dong bill (paper currency), perhaps as a distraction while she waited. Or, was it an intended gift? Its value was about six US cents. When she arrived in the operating room the team set it aside during her 3 1/2 hour surgery.
Dr. Randy Robinson was assisted by the Vietnamese surgeons in removing the extra jaw, set of teeth, and second tongue. The procedure was officially called a right "hemi-Le Fort osteotomy".
Lanh tolerated the surgery well. When she was transferred to the recovery room, her 1000 dong bill was folded neatly and taped to her arm. Underneath the Vietnamese currency was a US $20.00 bill for her father to receive from the team.
Lanh recovered well without complications. We hope that her bouts of pneumonia will now cease. And we trust her loved ones are rewarded by gazing into Lanh's "singular face" now. We pray her future will be bright, for her to be educated and develop normally.