Minnesota nice is being proven all over again.
A young man from Africa says he is proof of that as doctors in St. Paul rebuild not only his face but his entire future.
Even for skilled specialists, the surgical case on the table before them is a challenge.
“It’s kind of like putting a puzzle together,” said one surgeon before the operation.
Yet, amidst the medicine and machines and mounds of surgical blue they never lose sight of the gentleman they hope to help.
“Just a quiet, gentle, very intelligent young person who, hopefully, his entire life is gonna change now,” said Neurosurgeon Eric Nussbaum.
His name is Tonderai Mandigumura. In early April, the 22-year-old flew to Minnesota from Zimbabwe to see if American doctors could accomplish what nearly two dozen operations back home have not: to free him from a life of hiding his deformity behind hats and scarves.
Mandigumura has a genetic condition called neurofibromatosis, sometimes called Elephant Man’s disease. Since childhood tumorous tissue has overwhelmed the right side of his face.
Craniofacial Reconstructive Plastic Surgeon Martin Lacey thinks he can help.
Mandigumura admits to being a little nervous.
“Is it going to be a series of operations or is it going to be one day?” asked Mandigumura.
“I think this one will be one long day,” said Lacey.
To know what they’re dealing with, a multitude of CAT scans map his body. The tumor has destroyed Mandigumura’s right eye and changed the shape of his skull around it.
To see if key arteries may have been altered as well, he’s given a cerebral angiogram.
It is here that Interventional Radiologist Mike Madison discovers the carotid artery in the right side of his neck is blocked, but his body has grown its own bypass vessels around it to feed the brain.
The big day was June 2. St. Joseph’s Hospital has donated its services and staff.
A trio of surgical specialists has volunteered their time. Nussbaum is joined by Lacey and Neuro Ophthalmologist and Plastic Reconstructive Surgeon Andrew Harrison. They expect to be on their feet, non-stop, for the next eight hours.
The first piece of tumor removed weighs over a pound.
From there the right side of Mandigumura’s face is literally peeled away so doctors can reshape the tissues beneath and reposition eyelid, lips and ear. There is constant consultation and team work.
“You know I think it’s critical in terms of doing a case like this,” said Nussbaum. “It crosses sub-specialty lines, so as a neurosurgeon this is much more than I could ever look at doing myself.”
“It is crucial I think to be able to work back and forth as we see the anatomy unfold, making decisions about what to do,” he said.
Because Mandigumura’s right eye is non-functional, it’s been removed. And now doctors are going to implant something called a Bio-Eye. It’s a placeholder until an artificial eye can be added in the future.
The center of the Bio-Eye is specially chosen coral, shaped into a sphere.
“And we wrap it in a donor sclera, which is the white part of an eye from a donor eye. And that allows us to attach the muscles to it so it can move with the other eye,” said Harrison.
Because tumor had greatly enlarged and moved Mandigumura’s eye socket, Harrison re-models it with pieces of titanium screen and bone. Even though this is not a cure for his condition, the tumors are very slow growing and doctors expect the results to be long-lasting.
“Neurofibromatosis is relatively common in the community. I think you’d be surprised,” said Lacey. “In the United States, we’re lucky. Things are caught earlier. We can intervene at an earlier stage and as a result not let them reach such extreme examples as this.”
What started before 10 a.m. concludes six hours later.
The surgeons spared Mandigumura two extra hours under anesthetic by avoiding the need to open his skull and expose his brain. The personal satisfaction sparkles in their eyes.
“It’s huge. It’s huge! I mean, like I said to the family, this is why we go into medicine in the first place,” said Harrison.
Exactly one week later the swelling is going down. In a few months, another procedure will refine his lips and face even further. He is staying with a St. Joseph’s nurse, also from Zimbabwe, who happens to be married to his cousin.
Fellow nurses put together a cookbook to raise money for his expenses. He says he is very touched by the outpouring of generosity.
“Yeah, everyone’s nice. Very nice treatment here. The hospital. Excellent care,” said Mandigumura.
In about two weeks Mandigumura will be fitted with a prosthetic eye. He is trained in business and accounting, but people have been reluctant to hire him. He hopes finding a job will be easier now when he goes back home.
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