30 years old Ms. Astha Mongia visited Sir Ganga Ram Hospital in February 2021 with a rare congenital fusion of the jaw joint with the skull bone because of which she was unable to open her mouth since birth. The mouth opening was so small that she was not even able to touch her tongue with hand. In last 30 years she was unable to eat solid and had difficulty in speaking. She had lost almost all her teeth due to dental infection. To make the situation even more complicated, the patient had a neuro-vascular malformation (Tumour) over the right half of the face, orbit and forehead. Also there was no vision in the right eye. It was such a complicated case that various leading hospitals in India, United Kingdom and Dubai had refused surgical solution.

According to Dr. Rajeev Ahuja, Senior Plastic Surgeon, Sir Ganga Ram Hospital, “For such patients (picture attached) to open the mouth, both the condyles (ball like head of jaw joint) have to be removed. Many a times a tongue like bony extension in front of ball joint known as Coronoid Process also has to be either removed surgically or at least fractured but in her case this was easier said than done because there was bunch of vessels surrounding the Coronoid Process on the right side”.

The team for this complicated surgery was lead by Dr. Rajeev Ahuja and was assisted by Dr Raman Sharma & Dr Itishree Gupta from Plastic Surgery, Dr. Ambarish Satwik from Vascular & Endovascular Surgery and Dr. Jayashree Sood & Dr Amitabh from the Anaesthesia team. They decided to go ahead with the high risk surgery after extensive discussions and planning with radiology & vascular experts.

Three weeks before the surgery the entire surgical area was injected with a sclerosant to shrink the blood filled vessels, as far as possible. During surgery her fused temporo-mandibular joint (jaw joint) was reached after slowly pushing aside bulky neurovascular formations. At this stage, any misadventure would have led to excessive bleeding and possible death on the table. After this both the condyles which were hampering opening of the jaw were successfully resected on both the sides. We also gently dissected and teased of the bunch of vessels around the outer side of the Coronoid Process to make space for cutting the Coronoid Process, to allow mouth opening. The whole surgery done on 20 March 2021 took three and half hours (3½ Hrs). At the operation table the mouth opening of patient was 2.5 cm.

At the time of discharge on 25 March 2021, her mouth opening increased to 3 cms. A normal person has a mouth opening of 4-6 cm. Speaking clearly for the first time after 30 years, Ms. Astha Mongia who is currently Senior Manager in Punjab National Bank said, “It is a miracle that I am able to open my mouth as well as can eat without any difficulty. I am very happy”.

According to Dr. Rajeev Ahuja, “Her mouth opening will further increase in the coming days by way of mouth opening exercises”.

According to Shri Hemant Pushkar Mongia father of the patient, “We had gone to leading Indian Hospitals, as well as to United Kingdom and Dubai but she was refused surgical treatment due to high risk involved. My daughter has suffered a lot in last 30 years, her mouth opening was so small that she could not even touch her tongue by hand. Today, after successful surgery she can not only open her mouth but also touch her tongue. “

Opening her mouth after 30 years Astha Mongia said, “Thank you lord and Doctors for this second birth”.

A case of medical negligence and deficiency of service filed by 60-year-old petitioner against an orthopedic surgeon and a hospital has been expelled by the District Consumer Disputes Redressal Commission of Jalandhar. The petitioner alleged that despite consent, no surgery was performed despite consent.

The plea submitted that the patient moved to the hospital for the treatment of displaced/broken bone of left arm. She was suggested surgery which was consented by her husband who immediately brought the medicines for the operations and provided them to the doctor in the operations hall so the treatment could begin.

However, the doctor did not perform surgery and put a plaster on the left arm instead to which the patient objected. The next day, she complained that the pain is very severe and unbearable. The doctor changed her medicine, but that too was not effective.

The patient was then shifted to another hospital and after examining all the treatment records, the treating doctor there advised surgery as per the consent of the patient which was done successfully.

The petitioner moved to the consumer forum alleging medical negligence and service deficiency against the previous hospital. The counsel and the doctor denied the allegations stating that the Anesthetist who was about to assist the surgery suggested that the patient is not in a condition to have a surgery due to her age and overweight and that the surgery could be a risk to her life.

It was also advised by the Anesthetist that after the treatment of POP, the wounds would stabilize after six weeks and then it would be ascertained whether she needed surgery or not, and she was asked to come for the follow-up action. The rest of the averments were denied by the hospital council and they prayed for dismissal of complaint. The doctor also stated that he examined the complainant for the purpose of suitability to undergo an operation and found that she was not conducive to undergo surgery.

After considering both the parties’ arguments, the commission observed and said that the doctor held the opinion that the patient needed treatment of POP as she is an aged 60-year-old patient and was overweight having her physical condition, not to the extent that she could withstand the surgery. The opinion of the Anesthetist who was to assist in the surgery also suggested that the patient was not fit to undergo surgery.

The bench noted and said, “We find that grouses of the complainant are that firstly her left arm has displaced/broken and need some surgery. Secondly when the treating doctor did not perform the duty as per the consent, we think that the above grouses of the complainant are not authenticated because the surgery given to the patient depends upon the doctor, and not on the patient and the doctor performed the duty as per his knowledge and caliber and he cannot depend upon the consent of the patient because surgery or given proper treatments to the patient is regular routine work of the doctors as per their profession.”

The commission observed one of the apex court’s observation and noted: A medical practitioner would be liable only, where his conduct fell below that of the standards of a reasonably competent practitioner of his field. Negligence cannot be attributed to a doctor so long as he performs his duty with reasonable skill and competence. It would not be conducive to efficiency of the medical profession, if no doctor could administer medicine without a halter round his neck.

The commission dismissed the complaint finding nothing on record of non-qualification of doctors or their inability to follow the medical protocol while prescribing the treatment of the complainant, saying:

In absence of an expert doctor’s report, we are unable to rely on the bald submissions of the complainant in this regard, who is not a medical expert person in the medical science, attributing medical negligence to OPs. We are unable to come across any substance on the file to prove medical negligence on the part of OPs.

surgery

Female Opens Her Mouth After 30 Yrs

Consumer Forum dismissed Medical Negligence case; consented surgery not performed