Stretching Bone, Molding a Face

Just moments after the birth of their second child, Barbara and Joe Munson knew that something was terribly wrong. Their newborn daughter, Emily, was rushed to the pediatric ICU, where she was intubated and placed on a respirator. Despite the confusion, it was painfully obvious that Emily had severe facial deformities. She was diagnosed as having Goldenhar's Syndrome, which in her case included cleft lip and palate, a severely underdeveloped lower jawbone, and incomplete eyelids. Although Emily was spared the cardiac and renal abnormalities often associated with this syndrome, she required a tracheostomy to ensure adequate breathing. Four weeks later, the Munsons brought Emily home, to a nursery filled with so much medical equipment it looked like an intensive care unit.

Gentle Methods, Better Results

Any significant abnormality at birth can be heartbreaking, but facial deformities are particularly devastating. Facial defects can range from quite simple to complex. Major bone structures of the face may be underdeveloped, malformed, or totally absent, often requiring multiple surgeries and bone grafting. In 1989, Dr. Joseph G. McCarthy, Director of the Institute for Reconstructive Plastic Surgery at NYU, pioneered a technique known as distraction osteogenesis, which has revolutionized the care of children and adults with facial deformities. The technique stretches and lengthens the bone over time by gradually inducing bone growth to repair defects - in essence, coaxing the body to repair itself. In mandibular distraction, lengthening of the lower jawbone, the procedure also helps to expand the soft tissues of the face, further improving facial symmetry.

This technique often spares a young child the discomfort and risk of a major bone grafting operation. Compared to earlier methods, this procedure is less aggressive and safer; instead of major surgery with a week-long hospital stay, the process is usually begun with a much simpler operation involving a one-day stay. The need to harvest bone from a separate site is eliminated, as is the need for blood transfusion. The results are superior, producing new bone of better quality, with little chance of relapse, as well as yielding better symmetry, dental occlusion, and airway patency.

Starting Early, Avoiding Trauma

Our goal," says Dr. McCarthy, "is to get these children to look as good as possible before school, to avoid the psychological and social difficulties that might be caused by abnormal facial appearance." To start the gradual process of mandibular distraction, the lower jawbone is cut. Two screws are placed on either side of the bone cut, and a "stretching" device is placed externally and attached to the screws. The device is turned daily to separate the bone segments at a rate of about one millimeter per day, and new bone gradually forms in the gap. When the desired result is achieved, the device is removed.

While Emily was still an infant, the Munsons took her to Dr. McCarthy at NYU, where he and his team of specialists, including Dr. Barry Grayson, the Institute's orthodontist, coordinated a comprehensive approach to address Emily's individual anomalies. It was clear that she would require several operations over the years.