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Tuesday, December 20, 2016

High-Res 3D Imagery - Pre-Surgery

Left Jaw

These 3D images from the Mayo Clinic show Katie's jaw anatomy much more clearly than anything we've ever seen before.  Most of us have a vertical bone (the ramus), which extends from the base of the skull downward.  Then, the jawbone itself is meant to attach to the bottom of the ramus, and extends horizontally so as to align with the upper jaw.

Katie is missing the ramus entirely.  Instead, she has only the lower jawbone, which is rotated upward without anything to attach to.  This is what causes her open mouth posture, and the small mouth that her tongue cannot fit into.

In the surgery this Thursday Dr. Matthews will fashion two ramus (vertical) bones from her own ribs, and will attach the new bone from the base of her skull to the end of her jawbone, forcing that lower jaw to rotate upward.  It is doubtful that he'll be able to completely close her bite so that her front teeth meet, due to the limitations of the soft tissue (skin, muscle, ligaments), but he will be able to get some of her back molars to meet, allowing her to once again chew.

Right Jaw

The Dr. expects her to experience more pain from the removal of the ribs than from the face, which is interesting.  She'll have her jaw wired shut for up to 6 weeks while the new bone heals and fuses.  Pam & Katie will likely stay in Charlotte for that entire period, though I have to return after 2 weeks to go back to work.

This is an entirely different approach than we've taken before.  Previously, the attempt was to GROW new bone through osteogenesis, and then "bend" the new bone while it was malleable, to rotate the lower jaw upward.  Soft tissue forced that bent bone back into its original shape, and thus nothing was gained.  This attempt makes much more sense mechanically, as it creates the normal architecture that makes for a functional jaw.

Katie was and is totally in control of the decision to proceed with this surgery.  Now that she is an adult, we relegated all decision-making to her, and this is the result of much prayer and fasting.  We pray for great success, and invite you to join with us in those prayers!

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