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This one is about: Facial Distraction Article


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His Surgery Brings A Smile

By Rachael Reynolds, Journal writer

At the tender age of 10, little Luke O'Lena has endured half a dozen major surgeries to help symmetrize his face.

Luke was born with a rare condition that left the right side of his face oddly unproportionate to the other.

Luke had a facial bone deficiency, making his right side crooked and caved in. A facial cleft left his lip split to his nose, as with his tongue, back to his throat. His nose and eyelid were also affected by the cleft, and he was born with only one ear and deaf. He required extensive reconstructive surgery.

Luke's problems were a result of a rare combination of the numerous clefts and a disorder called hemiafacial microsomia.

Surgery by surgery he's gotten closer and closer to looking like a normal little 10-year-old. But an experimental device on Luke's face is bringing him the closest.

"The doctors are getting us ready for the senior prom," said Luke's mother Karen, who is a teacher's aide for the Kankakee school district.

The device emplaced in Luke's most recent June surgery is the first one of its kind to be used in the Chicago area. McKay McKinnon, M.D., Luke's surgeon at the University of Chicago Children's Hospital, said the procedure has been used successfully, but only on a few hundred patients.

The O'Lenas, who live in St. Anne, were tempted with the procedure two years ago, but McKinnon wanted to begin on Luke only after he returned from Europe with his team, training and studying the procedure and its results.

It involves placing metal screw pins through the jaw bone, and then fracturing the bone between them. The pins move apart when twisting a gear. Instead of the fracture being moved closer like in regular healing, it is being manipulatively extended.

"What we're essentially doing is stretching the bones, forcing his face to grow," said Dr. Neil Warshawsky, Luke's orthodontist, who works closely with Dr. McKinnon.

Known as distraction in the medical world, it was first introduced by a Russian surgeon, Dr. Ilizarov, and used effectively for over 20 years on orthopedic patients in lengthening a limb shorter than the other.

Technology has transferred the procedure to the facial skeleton, and has been used clinically in the last few years, and successfully on animals.

But since it is so new when used on facial bones, "we are still learning a great deal about it," McKinnon said.

It will elongate Luke's jawbone in three directions. Earlier devices were only uni-directional.

Luke's experimental and sophisticated device actually has three gears that will allow this dimensional movement, done at home with by his mother. Karen twists the screw several times a day, each time slightly breaking Luke's jaw, which ultimately triggers a gradual growth of bone.

The unusual apparatus, called a distractor, will lengthen Luke's jaw over several weeks without having to borrow more bone grafts, McKinnon explained. Luke has already had two grafts to his jaw, using a rib and part of his skull.

This distractor will expand the bone at a controlled rate of one millimeter each day, and though it will require a few weeks more, ''there have been signs of bone consolidation,'' McKinnon said.

Because of Luke's crowded teeth, he has a second expander device attached to his permanent teeth.

And outstanding results have occurred. When he's older, Luke may only need braces, opposed to more jaw surgery.. "His teeth are straightening out quite nicely," Warshawsky said. "It's very obvious that it's working from the dental side."

Though doctors don't know the full extent of the results, "we do expect it to make up for lost bone that he's missing," McKinnon said.

Luke's surgery was well-timed to allow his involvement in soccer and Little League now that he's back at Clifton Grade School. Over the summer, it hasn't affected playing in the yard with his friends or 12-year-old brother, Evan, whom Luke especially looks up to.

"He doesn't complain one bit," said Luke's father, John, who works at Armstong. Through it all, Luke has been a trooper. Despite the unusual and conspicuous device on his face, "everyone's accepting of him. He's a very happy boy."

But in Luke's early years, Karen was hurting. "I know it's terrible, but I went through a time, thinking, 'Why did he live?' I went through a lot of hate and guilt. Luke looked in the mirror one day, and said, 'Mommy, my smile's getting straight.' It's all worth it."

The O'Lenas once met a couple whose child had similar problems as Luke; but when they saw his progress, they were stunned by the admirable transformation.

"Luke showed them a picture and said, 'I used to look like that.' I just want other parents to know that there is help out there,'' Karen said. ''I want them to know never to give up hope."

Luke is still growing, though, which may require additional bone distraction in the future because of the lack of genetic information telling his face to grow.

But McKinnon expects even more sophisticated devices to become available, shortening the time needed to complete such complex reconstruction.

"Luke will be ready for that prom," McKinnon said.


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