The nurse turned the screws for the first time at 18:45 EDT tonight, which starts the expansion process. You can see the wrench used; each side gets 2 full 360 degree turns twice a day for now. I'm sure he said we'll end up doing it 3 times a day once we're out of the hospital tomorrow. The overall concept is called osteogenesis, which means, "bone creation." The cut in each jaw bone is separated a tiny bit with each turn, causing the body to generate new bone to fill in the gap. Since KT has no real jaw joint, he says the expansion will first push the upper pieces to the rear until they hit "ground" at her skull. Once that happens, the lower pieces will begin to extend pretty rapidly. We're looking for 40 mm of extension (4 cm or 1.6"). KT seemed okay with the turning - up tight and apprehensive, but not too painful.