A face rebuilt, a life reborn

PHOTO: A face rebuilt, a life reborn

XI'AN, China - For the first two decades of her life, Wang Na just wanted to be able to smile and chew food.

The 23-year-old was born without an upper jawbone or upper gums, making the middle of her face look like a sunken pit.

She rushed back home, crying, the first day she went to school and had never gone back.

"I had to cover my face with a scarf when I went out and I was often ridiculed by other kids because I couldn't speak clearly," she recalled.

That was until May 2010 when her face was finally rebuilt by doctors after four years of treatment.

For the first time in her life she could smile like a normal person, and chew and taste food. It was like being reborn.

Wang, from Shaanxi province, had been abandoned soon after her birth.

Wang Youren, 67, Wang's adoptive father, recalls the night of July 24, 1988, when he heard a noise outside as he prepared to go to bed.

He had thought someone was trying to steal his cow, but instead found a package of bedding next to his firewood stack.

Inside, the father found Wang Na and brought her into the house.

In the light, the couple found a piece of paper with the baby's date of birth: July 23, 1988.

The couple felt glad when they found that the baby was a girl as they had two sons and no daughters.

But their hearts sank when they found, while trying to feed her, that the baby girl had no upper jaw.

Borrowed money to feed her

Special feeding

Though their elder son had been born deaf and dumb, the couple decided to adopt her because they thought she would die, if abandoned again.

To feed her, the poor family borrowed money and bought a dairy goat to produce milk.

As Wang Na grew, her mother mashed steamed bread and rice into a paste to feed the girl - a special feeding that lasted more than 20 years.

Wang Youren recalled taking her to a rural fair where many people looked at her as a monster. "I was even scolded and told not to bring her out to scare people," said the father.

The family had tried to restore her face since she was eight, visiting many hospitals in the province, but were told there was no way.

One day in 2006, a neighbor who worked in Shaanxi's capital, Xi'an, suggested that the family go to the Dental Hospital of the Fourth Military Medical University.

Liu Yanpu, a professor and director of oral and facial plastic surgery in the hospital, knew the case was rare. The cost of treatment, as well as the difficulties and risks, were quite high.

"Seeing the praying eyes of her parents and Wang Na, I couldn't refuse the family."

The doctor reported the case to the head of the hospital next morning and the hospital decided to give her free treatment.

"I knew we would take risks to do this surgery, as there was no successful experience to learn from," said Zhao Yimin, director of the hospital.

The rest is history.

When Wang Na returned home with her restored face, she was introduced to many men for marriage.

After thinking for many days and nights, she made the unexpected decision to marry her elder deaf-mute brother, who had looked after her for the past two decades.

Life has never been better for Wang, she said.

"I have had double happiness during the past half year," Wang continued.

"One is that I held my wedding ceremony in November. The other is that I got 0.67 hectares of the best farmland from the villager's committee to grow vegetables for my new life."

The journey to a new face

The journey to a new face

Zhao Jinlong, a maxillofacial surgeon with the Stomatological Hospital of the Fourth Military Medical University in Xi'an, the capital of Shaanxi province, remembers the first time he saw Wang Na.

"When the kid took off the scarf around her face, all the doctors and nurses were speechless," Zhao says. "We had never seen anyone like her."

That was in early 2006.

Wang, 23, was born without her upper jawbone. While growing up, the bones and tissues that should have grown onto the upper jawbone also degenerated.

When she came to the hospital, the middle part of her face looked like a pit. Her nose was tiny. She had no upper teeth, and her mouth seemed always ajar as her upper lip sank into the mouth, without support from the upper jawbone.

Her profile was u-shaped, which is how she got the nickname, "pit-faced girl".

The "pit" was filled after four years of free-of-charge treatment in the hospital, which included a dozen of operations and numerous examinations.

"We were reportedly the first in the world to successfully reconstruct a face without an upper jawbone," says Wang Limin, the political commissar of the military hospital, adding that more than nine departments and nearly 20 experts were involved.

"Although we had all the technology and expertise in the different departments, it was the first time we combined all the know-how in one single case," says Lei Delin, a maxillofacial tumor specialist, who was also one of the chief doctors for Wang.

Lei says they were initially quite clueless about where to start.

Three phases

Three phases

In early summer of 2006, the medical team conducted a series of examinations on Wang, held several seminars, and finally agreed on a three-phase operation plan.

Phase 1 was to lengthen and thicken Wang's cheekbones through distraction osteogenesis - to gradually move the two bone ends apart, allowing a new bone to form in the gap.

Phase 2 was to transplant an artificial upper jawbone made from Wang's calf bone.

And Phase 3 was to reshape the nose and lower jawbone and implant dentures.

Doctors used computer modeling throughout the process.

"The first phase is the most important, because cheekbones support the upper jawbone," says He Lisheng, a maxillofacial trauma expert. He notes the human skull is a whole connected only by sutures, and any change changes the forces among the bones.

View pictures below for visual explanation of the four phases:

Risky procedure

Risky procedure

Wang Na's cheekbones were very thin and, thus, were very close to the brain. If the distraction operation was not conducted precisely, both the brain and the eyes would be harmed.

Doctors faced another delicate challenge in making sure the soft tissues on the old bones would not add too much pressure on the growing bones and disturb the new bones' orientation.

Wang received her first major operation on Sept 5, 2006. Her cheekbones were cut open to place a tailored distraction osteogenesis device designed using computer modeling. The operation lasted about four hours and was a success.

The cheekbones projected about 0.7 mm per day. Seven months later, Wang's cheekbones were ready for the next stage of transplanting. Such a procedure is nothing new, but Wang's case was special.

"We created a whole upper jawbone and put it onto the cheekbones we had reconstructed, and there were a lot of challenges," He says, adding that the specialists had difficulties designing the shape and position of the upper jawbone because Wang's lower jawbone was also deformed.

After several discussions with painstaking attention to details, doctors decided to make a horseshoe flap of the bone, with the flesh and the skin resembling the upper jawbone, made from a 14-centimeter piece of fibia.

"That was the best method we could think of to ensure the safety of her leg and the success of the transplant," He says.

They faced other risks. Apart from the danger of infection, He says their major concern was the dovetailing of the blood vessels in the connecting parts.

"If the blood vessels failed to properly grow onto one another, the delivery of nutrients would be insufficient, and the tissues would likely die on large scale. That would mean the transplant's failure," He explains.

Although much preparation was done, the stitching of the blood vessels would largely depend on the experience and performance of microsurgical experts and cooperation among the medical staff.

The stressful and backbreaking operation took 11 hours on April 18, 2007. "Finally, we were able to breath," He recalls. "The kid recovered quickly, and she had a new look."

On March 14, 2009, as the artificial upper jawbone and tissues healthily stabilized, doctors put the dental implants into the bone, reshaped the lower jawbone and reconstructed the nose.

On May 17, 2010, Wang received her final operation. The hospital's president Zhao Yimin implanted her dentures.

As the treatment progressed, Wang became confident and smiled often. Nurses observed she would initiate conversations with strangers and even help care for younger patients.

Wang had more than a facelift. The once timid and introverted girl, who hardly spoke and would always tip-toe while avoiding eye contact, is a changed person.

"I'm happy with my look," Wang says.