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Thursday, June 19, 2014

Facial transformation

We met with Lucy's cleft surgeon, Dr. Vicari, last week for a checkup and consult for her next surgery. We were given two options to repair her fistula. Do a bone graft in the next year with a man-made product called Actifuse, repairing and straightening her nose at the same time. This will give her several years to see if/how much her bone grows over the graft to seal it. Or we can put it off until she's between 8-10 years old and use bone from her hip and repair her nose at the same time.

We've decided to move forward next summer with the Actifuse in order to *hopefully* spare her the second surgical site on her hip. If the Actifuse fails, she can then have the hip bone taken at the later age but there's a good chance we won't need that at all. The earlier surgery on her nose is also better done prior to elementary school when children are much more apt to point out her crooked nose and make her feel badly about it. We've had a few questions already from some of her classmates but Lucy has handled it well, saying, "I had a cleft lip and it just bent my nose! Isn't it pretty!". She is such a positive, cheerful little girl!

This graft is to eventually allow her to have dental implants to fill in the missing teeth from her cleft. This will not happen until her late teens when her face has stopped growing. In the interim, she will wear flippers (retainers with false teeth) to fill in the gaps in her beautiful smile.

Our orthodontist shared the before and current photos of Lucy's facial transformation. It really is amazing to see how her face has changed from December 2012 to June 2014, all without surgery. All of the movement in her face/jaw has happened only with the use of her mouth and face jewelry.

These were taken December 2012, prior to any orthodontic appliances. You can see in the top right photo that she was unable to show all of her teeth when she said, "CHEESE!"
These were taken June 2014. Amazingly, her nose is not as bent as it once was and she has lost the flattened profile that is typical of most cleft children. And she has cheekbones!
Here are the views inside her mouth from 2012. Her underbite was pretty severe.
And these were from this week. You can see that her teeth are headed in the right direction.
Another view from 2012. Her upper palate is on the left.
 And again, from this week. Her upper palate is on the left and top right (showing her upper mouth jewelry).
This was the report from the orthodontist to the surgeon.

"As you'll see, her arches have rounded out nicely and her tongue now has plenty of room to fit up easily into her hard palate.  I will just be maintaining the correction and nudge it wider and anteriorly as needed until you do the grafting; Lisa says you gave her the option to do now with synthetic bone, or later with hip bone…..she seems ready now."

So it looks like we're aiming for surgery right after her last day of school next June. It will be a 2 week recovery period (no swimming, low activity level) so we'd rather do it at the first of summer than at the end.

5 comments:

mommy of 2 said...

Isn't the practice of medicine amazing! So happy for the great results so far. Yay! Here's to more progress in the next year.

Elizabeth said...

Wow! What great improvement. You have a wonderful team working with you to give Lucy the best. I think she is adorable now!

KJ said...

Can I ask what orthodontic appliance(s) she has used? Our son (5) just started with an orthodontic face mask to pull his upper jaw out. I'm hoping for great improvement like your daughter. What a difference!!

Katie

KJ said...

Can I ask what ortho appliances she has used? My son (5) just got his face mask yesterday to try to pull his upper jaw out. Your daughter's improvement is remarkable. I'm hoping for the same sort of change!

Katie

Lisa said...

Katie, she has a palate expander on the top and bottom of her mouth. She has also had the face mask that pulls her upper jaw forward. She was wearing it every night, then progressed to every other night and for now at least, she doesn't need it anymore. The palate expanders are removable and we turn them based on a schedule that varies depending on how her mouth is moving. We see the dentist every 3-4 weeks to check her progress and adjust the appliances as necessary.

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