Plastic Surgery Consult

Hi everybody,

Well, we are back at home. We had our appointment with Dr. Magee this morning. It was weird to be back at CHKD again. The last time I was there I was working at Operation Smile and was there for a world care patient. And now I'm back for my own little patient.

I think it went well overall. After looking her over, he thinks that she has a lateral facial cleft as well. We noticed an indentation that she has from her right ear to the corner of her mouth but didn’t know what to make of it. I guess now we know. She also has some small spots of indentations around her left ear. I guess it makes me feel lucky as far as facial clefts go. It could be so much worse.

He ordered CT scans of her head and neck. He is looking for craniosynostosis (premature fusion of the skull sutures), facial bone structure, and neck (vertebral) issues. Hopefully we’ll get that scheduled for the near future.

He explained a procedure that he believes would be best to fix her jaw. Most of what I have read is about jaw distraction which involves cutting the jaw and installing hardware and screws that you adjust as time goes by to extend the jaw. But the procedure he described is different.

He goes in from under her skin to minimize facial scarring and nerve damage. There is no way I could properly repeat what he said but basically, they cut her jaw and somehow use some bone from her skull to extend it forward. Screws and wires under her skin set the jaw in place in a forward position (like an under bite) and her jaw stays that way for 8 weeks until it heals. So, overall it is a quick repair. The best thing about this is that he believes it is best not to wait too long to do this procedure. That was music to our ears!

He said the negative side effects of the underdeveloped jaw are far worse: the trach, g-tube, no speech or sound, potential for oral aversions, etc. We couldn't agree more! So, he said that as soon as she is strong enough and we get the all clear from her cardiologist then we can do it.

So, as far as cardiology goes, I spoke with her DC cardiologist last week. When she is 5 months old they will re-assess her heart situation to determine which procedure to do. Because she has a large VSD (hole in between the ventricles of her heart) they have two options. They can do a single ventricular repair, or a double ventricular repair. We are hoping for the double ventricular repair because it is one big operation and then it's done. The single ventricular repair takes 3 separate surgeries over a period of time. Well, that’s everything in brief. Well, it is getting late.

Talk to you later,
-Christy