Roman had initially sought medical attention after experiencing persistent tearing from his left eye.
At first he appeared to be suffering from a relatively minor problem but was then diagnosed with a rare and aggressive adenoid cystic carcinoma originating in the nasal cavity.
By the time he arrived at Beilinson Hospital, the cancer had spread into the eye socket, facial skeleton, frontal bone, skull base and dura, the protective membrane surrounding the brain.
Chemotherapy failed to halt the progression of the tumour toward the brain, leaving surgery potentially as the only option.
Dr. Esamat Najjar, Director of the Head and Neck Oncologic & Reconstructive Surgery Unit at Beilinson-Clalit Hospital. (Image: Beilinson Clalit)[Missing Credit]
"They presented us with three choices," recalled his wife, Svetlana. "Continue treatments that weren't working, undergo an enormous operation with tremendous risks, or do nothing and wait for him to die. We are a family that never gives up. We chose to fight.”
Dr Esmat Najjar, Director of the Head and Neck Oncologic and Reconstructive Surgery Unit at Beilinson-Clalit Hospital, said the procedure was “at the limits” of modern surgical capability.
"This resection was at the very edge of what is surgically possible," he said. "Removing the cancer was only half the challenge. You cannot leave a person without a face. Our mission was not only to save his life, but to reconstruct the structures that would allow him to live with dignity and function again."
During the first 12-hour operation, surgeons removed the tumour together with the frontal bone, nasal bones, cheekbones, the entire eye socket and part of the dura to achieve complete cancer removal.
Roman then spent nearly two weeks recovering while awaiting final pathology results to confirm that no cancer remained before reconstruction could safely proceed.
After complete tumour clearance was confirmed surgeons performed a second, 10-hour microsurgical reconstruction.
Using bone, muscle and blood vessels harvested from the patient's scapula, Dr. Najjar and his team sculpted a new facial framework, rebuilding the forehead, cheekbones and eye socket.
The transplanted tissue was connected to blood vessels in the neck using microsurgical techniques, allowing the reconstructed tissue to remain alive and capable of healing through the intensive radiation therapy that will follow.
"His eye was essentially left without a socket to support and protect it," Dr. Najjar explained. "We had to build it a new home. At the same time, we had to recreate the protective barrier over the brain, restore the facial skeleton and make it possible for him to breathe, eat, speak and walk outside without feeling that he had to hide."
Dr. Noga Kurman, Head of the Head and Neck Cancer Service at Beilinson-Clalit Hospital's Davidoff Cancer Center, said the patient's tumor represented an exceptionally rare presentation of adenoid cystic carcinoma arising from salivary glands within the nasal cavity.
"When chemotherapy failed, we faced an extremely difficult decision," she said. "This type of cancer has very limited effective systemic treatment options, making radical surgery the only chance for cure. Watching so many specialities come together to offer this patient that opportunity was truly extraordinary."
Roman has now returned home and is breathing, eating and drinking independently. He is expected to travel abroad in the coming weeks to receive particle beam radiation therapy aimed at eliminating any microscopic residual disease.
"For me, it doesn't matter what he looks like," said Svetlana. "I love him exactly the same. The only thing that matters is that he is alive".
