A young girl’s face is stretched in innovative surgical procedure

Cynthia Maldonato is 11 years old. She loves to sing in her church choir and her favourite subject is math. Instead of sporting the usual ’tween wardrobe of jeans and a hoodie, during a recent visit to the Montreal Children’s hospital (MCH) of the McGill University Health Centre, Cynthia wore a skirt, blouse, jacket and black pumps. While the vast majority of people were usually kind and even protective towards Cynthia, there were a few who, unwittingly or not, made insensitive and hurtful comments about the way she looked. Cynthia was born with Crouzon Syndrome, a rare genetic disease which causes premature fusion of a baby’s bones. As a result, Cynthia’s skull was completely misshapen, her eye sockets were too shallow which made her eyes bulge. She had difficulty breathing and a significant underbite. “Her face was bowl shaped,” says plastic surgeon Dr. Mirko Gilardino, the director of the MCH craniofacial and cleft surgery team, who is one of two surgeons involved in Cynthia’s care. “She had a very restrictive mid-face that was almost caved in completely.” In January, Cynthia underwent a newer type of surgery, the first of its kind to be done in Quebec. The surgery, performed by neurosurgeon Dr. José Montes and Dr. Gilardino, essentially allowed her mid-face, orbits and forehead to be stretched forward. During the challenging six-hour operation, the surgeons peeled off her face after making an incision from ear to ear. Then Dr. Montes used a special surgical saw to remove her forehead. At this point, Dr. Gilardino stepped in. using a surgical chisel and hammer, he cut the bone along both sides of her face and across the bridge of her nose so the whole face became mobile. Cynthia was then fitted with an external distractor halo. The semi-circular metal device looks like something out of a science-fiction movie. It was attached to the sides of her head with screws, just above and behind her ears. Dr. Gilardino also inserted four screws into Cynthia’s face. Wires attached the screws to the halo. The surgery went extremely well. About a week after the surgery, Dr. Gilardino started the process of advancing her face, one millimetre per day. “Believe it or not, her parents were turning the four screws on Cynthia’s face twice a day, morning and night,” says Dr. Gilardino. “The stretching really doesn’t hurt, but it pulls the face forward half a millimetre at a time over a period of three weeks.” it works somewhat like braces on teeth. As her face was stretched, her eyes became less prominent, the orbits deepened, and her teeth became more aligned. “I adjusted the alignment of Cynthia’s face, pulling the bones of the face upwards, downwards, to the left or to the right,” says Dr. Gilardino. “It is far from perfection, but it is a nice controlled gradual movement.” Once the period of stretching was over, Cynthia continued to wear the halo for about two months to allow her bones to set. The distractor was then easily removed. The new technique has significant benefits in terms of post-operative infection, reducing the risk of infection to virtually 0 per cent. Dr. Gilardino estimates he may do as many as four of these surgeries per year.