Mold of Mohammad Rasheedy’s jawline compared with illustration of normal human skull.
When Mohammad Jawad Rasheedy was an infant, he fell—no one knows exactly how or when—and injured his jaw. His family didn’t know the extent of his problem, because he wasn’t yet verbal or eating many solid foods, and besides, medical care was scarce in
their war-torn hometown of Kabul, Afghantistan.
But as Mohammad grew, it became increasingly clear that he’d taken more than a minor tumble. His lower jaw slowly became locked in place, leaving him unable to open it more than a centimeter. Because of this severe ankylosis, he was restricted to a liquid diet consumed through a straw that poked through teeth that grew outward from the force of his tongue. His limited motion significantly affected his speech, so only his family was able to understand him. He couldn’t brush his teeth, leaving them vulnerable to decay.
When he was 4 years old, a charity organization flew him to Germany for surgery. It only slightly improved his problem. Ten years later, his brother Abdul Hameed realized that only treatment at one of the world’s best hospitals might help Mohammed. Eventually, he reached out to Johns Hopkins, connecting with maxillofacial surgeon Alexander Pazoki
and director of the division of oral and maxillofacial surgery and dentistry at Johns Hopkins.
“He’d lived so long like this,” Pazoki says. “At this point, we had to do what we could to get his mouth open again.”
CT scans taken in Afghanistan showed complete ankylosis of the left
temporomandibular joint to the glenoid fossa and zygomatic arch and temporal bone, along with an extension of the coronoid process. There was also complete ankylosis of the coronoid process to the zygomatic arch on the right side. After Mohammad and Abdul came to Johns Hopkins in March 2015, Pazoki and his colleagues confirmed this diagnosis with a 3-D CT scan, using the collected data to create a stereolithographic model for better evaluation and planning for surgery.
In June, Pazoki, along with facial plastic and reconstructive surgeon Kofi Boahene
and their colleagues began the four-hour procedure to correct left mandibular condylectomy, a bilateral mandibular coronoidectomy, and an excision of a hyperplastic bony mass on his jaw and temporal bone. To prevent his jaw from fusing shut again, they also grafted cartilage and skin taken from his ribcage onto his temporomandibular joint.
Upon awakening from anesthesia, Mohammad was scared, Abdul remembers; he worried that the numbness in his lips and tongue were permanent. But the next day, after the anesthesia completely wore off, he was smiling and sticking his tongue out—for the first time in over a decade. He has continued to improve with physical therapy over the past few months, Pazoki says, eating a soft diet and relearning how to speak.
Though Mohammad still has a long way to go, with further surgery slated after he’s finished growing to perform a complete bilateral joint reconstruction, he’s come a long way in just a few short months, Pazoki says.
“Kids should be able to eat ice cream and pizza, brush their teeth, and tell jokes. These are things we take for granted,” Pazoki adds. “Now Mohammad will be able to enjoy his life.”
ABOUT THE OPERATION
In a four-hour procedure, Mohammad Rasheedy received a mandibular condylectomy, a bilateral mandibular coronoidectomy and an excision of hyperplastic bony mass on his jaw and temporal bone. To prevent his jaw from fusing shut again, cartilage and skin were taken from his ribcage and grafted onto his temporomandibular joint.
By the next day he was smiling and able to stick his tongue out for the first time in over a decade.