What to Expect:
Mandibular Distraction
Before Surgery:
You will meet with your surgeon to discuss the details of the surgery and to have all of your questions answered in detail. A preoperative history and physical exam will be done, and you will be given an informed consent form to sign that gives us permission to do the surgery. You will also get detailed instructions for the preoperative and postoperative period, including wound care, and how to detect problems. Your baby will have to have an empty stomach before going to surgery, and you will be given specific instructions on when to stop feeding him/her. If your baby gets sick before surgery, you should notify us so that we can decide whether or not to proceed with the scheduled procedure.
You will also have an appointment this same day with the anesthesiologist in pre-operative clinic. At this appointment you will be instructed when to arrive the day of surgery and when your baby needs to stop eating and drinking before surgery. We encourage you to have the baby drink a lot the day before surgery and to wake them up early in the morning to give them something to drink up until the time when oral intake should be stopped. It is more difficult to place IVs in babies who are dehydrated (from not drinking enough fluids). During this visit with the Pre-op clinic you will also be instructed where to check-in on the day of surgery.
If you are traveling from a long distance and would like to stay at the Ronald McDonald house the night before, these arrangements can be made.
If your baby is in the Neonatal Intensive Care before surgery because of airway problems, the surgeon will visit with you at the baby's bedside to go over the information and answer any questions you may have prior to surgery. Arrangements will be made for the baby to be transferred to the Pediatric Intensive Care Unit the day before surgery.
The Day of Surgery:
You will be instructed to arrive at the Surgery Center an hour or two before the surgery. You will check in at registration on the first floor of the hospital (unless your baby is already in the hospital). Once you are checked in, you will be taken to the pediatric holding area (you may be with your child in this area). When it is time for the baby to come down to the operating room, you will be instructed to bring the baby to the holding area of the operating room (again you will be allowed to be with your baby). The baby will be examined by the plastic surgeon, the otolaryngologist, and the anesthesiologist again and this is a good opportunity to ask any last minute questions you may have. The baby will be given some oral medication to help make them sleepy. When it is time to go back to the operating room, the anesthesiologist will carry the baby back to the operating room and you will be shown how to obtain a pager so that we may be able to contact you during the case.
The baby will be put under anesthesia using a mask. Once he/she is asleep, the IV will be started and the baby will be intubated (the breathing tube will be inserted to breathe for the baby during surgery) if he/she is not already intubated. A catheter will usually be placed in your baby's bladder before surgery since it may be a long procedure. The baby will be positioned on the table and prepared for surgery. Once the case starts, the nurse in the operating room will call out periodically to update you on the progress of the surgery. When surgery is almost complete, the nurse will call you to come to the waiting area to meet with your surgeon, who will discuss the surgery with you.
The baby will remain intubated (have the breathing tube in place) and will be transferred to the Pediatric Intensive Care Unit. Once the baby is settled in, you will be able to visit with your baby. The breathing tube will be in place, and the baby will be sedated. Do not let this alarm you. Your baby will have an incision on either side of the jaw with small distractor "activation arms" sticking out. The incision is kept open to air but will have bacitracin ointment on it; the nurses will apply the bacitracin ointment to the incision regularly. The baby will remain intubated until adequate distraction has been achieved to prevent further airway problems.
The baby will remain in the PICU for several days. Once the baby is medically stable, he/she will be transferred to the pediatric ward.
In the Hospital:
One parent is allowed to stay with the baby during their hospitalization. There is a waiting room at the end of the hall of the pediatric ward which has chairs that convert into beds. The other parent is welcome to stay there, and the parents may switch off during the course of the baby's stay.
Your baby will be visited each day by the plastic surgery team. You will be given an update on your baby's condition each day. Please feel free to ask any questions during this time. You will also be visited daily by the pediatric plastic surgery nurse who will ensure that you understand how to care for your baby once they are discharged. All of your questions will be answered, and you will receive detailed discharge instructions before you leave the hospital.
A distraction table will be constructed for your baby. The distraction table will detail how often the distractor will be turned and the millimeters of distraction. The surgeon or the nurse will turn the distractor using a special screwdriver. Once we have reached the maximum distraction desired, the distractors remain in place for approximately 6 weeks until we can obtain a CT scan to make sure the bone has re-ossified (grown in between the gap created).
After Discharge until the First Postoperative Clinic Visit:
Your baby will be discharged with the distractors in place and with instructions to keep bacitracin ointment on the incision sites.
Your baby will be seen in the clinic for the first postoperative visit approximately one week after surgery. During this first week, he/she may not be quite normal; babies can be more fussy than usual or have disturbed sleep schedules.
When your baby comes to the clinic, the incisions will be examined and we will address any concerns you may have.
Subsequent Postoperative Visits:
The next postoperative visit occurs at three weeks after surgery. In most cases, after the three-week visit, we will see your baby again at six weeks postoperatively. At the six week visit, a repeat CT scan will be ordered to ensure that the bone in the mandible has re-ossified. If this is determined to be the case, the distractors will be removed and the incision sites will be allowed to heal on their own. You will be given silicone sheeting, and instructed on when and how to apply it to the scar.