In an operating room at Tisch Hospital, Dr. Adam Jacobson (right) and chief resident Dr. Joseph Lebowitz review a surgical plan based on CT scans provided by the patient’s physicians in Mongolia.
Credit: Mateo Salcedo
On a surgical mission to Mongolia, Adam S. Jacobson, MD, and his colleagues met a patient they simply couldn’t forget. The weeklong trip in May 2024 was sponsored by the KLS Martin Corporation and organized by the Virtue Foundation, a nonprofit that recruits volunteers to provide advanced medical care and train local clinicians in developing countries. Dr. Jacobson, director of the at NYU Grossman School of Medicine, led a team of one dozen surgeons, residents, nurses, and technologists from NYU Langone Health. They were examining candidates for treatment at a hospital in the capital city, Ulaanbaatar, when the boy and his father arrived.
Byamba Erdene-Amgalan was a 16-year-old who, two years earlier, had undergone surgery for a benign tumor on the right side of his lower jaw. After removing half the jawbone, the local surgeons inserted a metal plate to fill in the gap. But the implant soon fractured, and a replacement device only made matters worse. Byamba was unable to open his jaw enough to fit one finger’s breadth. He couldn’t eat solid food, his speech was severely impaired, and he suffered constant pain. Pressure on the nerves had weakened his facial muscles, making it almost impossible to smile—not that he often felt like it.
Worst of all, the implant’s titanium joint was working its way into the base of the teen’s skull. “Without intervention, it would have penetrated the cranial vault and reached the brain, potentially causing fatal complications,” Dr. Jacobson explains. Fixing the problem, however, would be a complex process, requiring resources that were not available locally.
Dr. Jacobson and two frequent collaborators—Jamie P. Levine, MD, chief of microsurgery, and David Staffenberg, MD, vice chair of pediatric plastic surgery, both members of the —concluded that there was nothing they could do for Byamba during their visit. But once they flew home, recalls Dr. Levine, “This young man’s situation weighed on us. We wanted to find a way to help him.”
Returning to Mongolia with the necessary equipment and personnel was impractical, so Dr. Jacobson pursued an alternative strategy: bringing the patient to New York. His approach was characteristically methodical. First, he and Dr. Levine used KLS Martin’s medical modeling software to create a surgical plan based on CT scans provided by Byamba’s physicians. “Everything was mapped out, down to the millimeter,” says Dr. Jacobson. Then he reached out to NYU Langone leadership, which agreed to provide medical and surgical care without charge. Finally, he persuaded the Virtue Foundation to cover travel and lodging expenses for Byamba and his dad.
Having nailed down these logistics, Dr. Jacobson ordered 3D-printed cutting guides and hardware, designed to match the patient’s anatomy and assist in performing precise bone cuts. On March 7, 2025, Byamba was wheeled into an operating room at Tisch Hospital for an eight-hour surgery. Coincidentally, a group of Mongolian surgeons, who had been training at NYU Langone as part of a program sponsored by the Virtue Foundation, were on hand to observe.
The procedure, known as a fibular free flap reconstruction, is typically used to replace cancerous bone in the jaw or bone destroyed by trauma. Surgeons harvest a piece of the outer lower leg bone, or fibula, along with some skin and two blood vessels—an artery that supplies blood to the bone segment and a vein that drains it. After sculpting to fit the contours of the jaw, the flap (as the assemblage is called) is fastened in place with plates and screws, and the vessels are stitched to those in the neck with the aid of a microscope.
An additional challenge for the surgical team would be removing Byamba’s deteriorating implant. But each surgeon had more than two decades of experience, and they had tackled many tough cases together. “We have overlapping skills, but each of us brings unique expertise to the equation,” says Dr. Levine. “For a venture like this, it helps to have more than one brain.”
That became apparent soon after Dr. Jacobson exposed the jaw. The metal joint, he found, was buried in a layer of new bone at the skull base that imaging hadn’t revealed. “When you’re dealing with a person who’s still growing, it changes the dynamics,” explains Dr. Staffenberg, who had encountered similar surprises in other pediatric patients. “But you don’t often see something this severe. It was like a hinge covered in cement.”
Using a drill, Dr. Staffenberg freed the joint, enabling Dr. Jacobson to extract the old plate as Dr. Levine harvested bone and tissue from the boy’s leg. The three surgeons then teamed up to shape and implant the flap and meticulously close the incisions. By the time Byamba was discharged a week later, his jaw had regained its normal range of motion. He was speaking easily, smiling freely, and scarfing down hamburgers like any other teen.
“A year ago, I was hoping the American doctors would come back to operate on me,” Byamba said through a translator. “I never could have dreamed of coming to the United States for this procedure. Now, I’m confident about my future. I feel like I can do anything.”
After a month of recuperation—including a healthy dose of sightseeing—Byamba and his father returned home. He hopes to return to America one day to study IT engineering. “This experience planted a seed in his heart,” says Odontungalag Tseveenturen, MD, one of the Mongolian doctors who witnessed the surgery.
It also planted a seed for Dr. Jacobson, who plans to launch more global rescue missions. “Being able to bring this kid here and give him the care he deserved was an amazing feeling,” he says. “Changing patients’ lives for the better is why all of us do this job.”
