How is Hafizur doing with his newly reconstructed jaw?

Hafizur's story first arrived on social media almost by accident. 

A video titled 'Apu Bhai buying Ferrari car' went viral on social media, where the boy, Apu bhai, said it required 'guts' to buy a car that costs Tk2.87 crore. 

While many youths shared the video on their profiles, asking questions like, "Who needs education if content-making can get you a car like that?"Some began sharing a photo of Hafizur's surgery as a response to that, stating, "It is far more honourable to save someone's life by doing a complex surgery than buying a car. So please stick to your studies."

So who is this Hafizur? What surgery did he undergo? Is the story even real? The TBS team decided to pay Hafizur Rahman a visit to find out.

Whether he will speak to you or not depends on his mood. The 14-year-old, diagnosed with autism, would not even look at us while his mother Taslima Begum wiped the drool off his mouth. 

"He does not have his lower teeth, hence the excessive drooling," she said.  

It turns out, it has been nine months since Hafizur underwent life-changing maxillofacial surgery, in March 2024. Ninety percent of his mandible had to be removed before his jaw was reconstructed. This was an unprecedented case, and performing such a major surgery on a child with autism is extremely rare in Bangladesh. 

"He is so hyperactive that we have to sedate him before any scan," said Dr Nitish Krishna Das, the dentist who led the complex maxillofacial surgery. Managing a child with autism for an extensive surgical procedure required not only medical expertise but also immense patience and psychological preparation.

"Generally, when patients come in with oral tumours or growths, we perform surgery to replace half or less of the mandible, which is the largest bone in the human skull. But in Hafizur's case, this was the first time we had to discard more than 90% of his mandible before we could replace it" explained Dr Nitish. "After that, we reconstructed the jaw. This was an unprecedented case, and performing such a major surgery on a child with autism made it even more challenging."

His jaw has healed, and now the doctors are preparing for the next crucial step: implanting new teeth on his lower jaw. The medical team at Suhrawardy Medical College Hospital is now waiting to undertake the procedure, which will complete Hafizur's transformation.

But it has not been an easy journey for the family or the doctors. Hafizur has always been hyperactive, making any medical procedure a significant challenge. 

Early signs

The medical condition began when he was just three or four years old. Hafizur's parents noticed a small, unusual growth in his lower jaw. Initially, they did not think it was anything serious, as it grew very slowly. 

However, the growth had become more noticeable by the time he was six. His mother recalled, "We went to many doctors and surgeons, but no one wanted to take the risk of performing a surgery. So they all told us to wait till he gets older."

Given his autism and hyperactivity, most doctors hesitated to perform surgery due to the risks associated with sedation and post-operative care. Even neurosurgeons suggested waiting, fearing that anesthesia could cause complications. 

"Over the years, as the tumour continued to grow, it gradually took over Hafizur's entire lower jaw, making everyday functions like eating and speaking increasingly difficult", said Dr Nitish.

After years of uncertainty, Hafizur's family finally turned to Shaheed Suhrawardy Medical College Hospital in 2022, where they met Dr Nitish Krishna Das, assistant professor at the Department of Oral and Maxillofacial Surgery, and his team. In 2024, after thorough assessment and preparation, the doctors decided to proceed with the complex surgery.

The bone grafting procedure

One of the most difficult aspects of the surgery was shaping a new jaw from Hafizur's own bone. The surgical team had to take bone from his left leg and manually shape it into a jaw structure.

The procedure involved several intricate steps. 

First, the damaged jawbone, along with affected muscles and nerves, was completely removed. Then, a section of the fibula, approximately 18 centimeters long, was extracted from Hafizur's leg. This bone was then grafted into six pieces and manually shaped to form a new mandible. Finally, the reconstructed jawbone was carefully placed into Hafizur's mouth and secured in place.

"The reason we grafted from the fibula is because when we walk or stand, it's the tibia bone that carries most of the weight. So if we take the fibula, it doesn't affect the patient much. Also, we cannot take bones from the hand because the hand bones are not that strong and they are thinner, which is not ideal for jaws," Dr Das explained.  

"Internationally, the doctors use a stereolithographic model (a 3D replica of a patient's facial structure that's made from a photosensitive resin) for such maxillofacial surgeries. After that they produce CAD/CAM (Computer Aided Design/Computer Aided Manufacturing) of the bone structure using a special CAD machine. However, we had to do it manually, as we do not have such high technology in Bangladesh", Dr said.  

The entire process took 11 hours, requiring meticulous precision.

The challenges did not end with the surgery though. Post-operative care was crucial to ensure that Hafizur's body accepted the new bone structure without complications. One of the biggest concerns was his hyperactivity.

"Normally, after such surgeries, we monitor patients in a general ward and let them recover gradually. However, in Hafizur's case, we had to keep him under close observation in the ICU for 10 days," said Dr Nitish. "There was always a risk that he might become hyperactive and disturb the stitches, which could lead to severe complications."

Given the risks involved, every step had to be handled with extreme caution. "Even a minor mistake could have led to a major infection or, worse, death," Dr Nitish added.

For Dr Nitish, the case was not just a medical challenge but also a deeply emotional one. "When surgeons refused to do the surgery, Hafizur's father, Sharifuddin, held my hands and said, 'Please do the surgery. Even if my son dies in the process, I will not blame you. But please, take the risk.'"

The emotional weight of this request stayed with the doctor throughout the months of preparation. Although the surgery itself lasted 11 hours, the team spent nearly three months studying Hafizur's condition, analysing possible risks, and preparing themselves mentally for the operation. "It required a great deal of psychological preparation, not just for the family but for us as well," said Dr Nitish.

A medical team of 10-12 specialists worked together to ensure the success of the surgery. "I have to say, the anesthetists among others were amazing. The way they managed Hafizur's condition for 11 hours was commendable," he said. "At the end of the day, this was a team effort."

A personal tragedy in the midst of recovery

While the family was awaiting Hafizur's recovery and the next stage of his treatment — teeth placement — an unexpected tragedy struck. In October 2024, Hafizur's father, Sharifuddin, suffered a heart attack and passed away.

For Taslima Begum, the loss was devastating. "After my husband's death, I didn't know what to do. He was the sole earner of our family," she shared, her voice breaking. "Now my elder sons are trying to establish themselves as soon as possible to support the family."

Hafizur has two elder brothers- the eldest Abdur Rahman Siam is preparing for undergraduate admission studies and the next brother Twasim is currently studying in a Polytechnic Institute.

"For the past nine months, we have been waiting for his gums to regenerate on his jawline. The doctors have said that hopefully they will start working on his teeth placement surgeries this October. It will be done in six stages and will require around Tk3 lakh," said Taslima Begum. 

Despite the immense personal loss, Taslima remains focused on Hafizur's progress. The doctors have advised waiting a full year before proceeding with dental implants. Until then, Hafizur continues to recover, adapting to his new jaw and slowly regaining his ability to eat and speak more comfortably.

The family is determined to see this journey through, holding onto the hope that Hafizur will soon be able to lead a more comfortable life.

Meanwhile, the doctors at Suhrawardy Medical College Hospital take pride in the success of the surgery. For Dr Nitish and his team, Hafizur's case has been an extraordinary learning experience, pushing the boundaries of what is possible in maxillofacial surgery, especially for patients with autism.

"We have come so far. Now, we just have to be patient a little longer," Taslima said.