Dr. Whitaker - Plastics 1978
Improvements Are Dramatic Mom Evening , Wtdn«dqy, June 21, 1971.— 31 Craniofacial Surgery Performed On Babies PHILADELPHIA (AP) - It was 25 minutes past midnight, Halloween 1977, and Carol Brennan had just given natural birth to a son. Suddenly she was gripped by fear. "As soon'as they laid my baby on my stomach I knew something was wrong," she recalled. "Of course I kept trying to convince myself it would be all right, that'it would correct itself, but deep down I knew." Daniel John Brennan was born with plagiocephaly, a defect caused by a misshapen skull. There was a dent on the right side of his head where bone growth was stunted and a slight bump on the left where his brain was trying to poke out. And his left eye was higher than his right. He was one of the 250,000 children born annually in the United States with congenital defects. Of those, one in every 10,000 babies comes into the world with major facial deformities. Not long ago, these youngsters, some truly grotesque anomalies, spent life's tender years the objects of wide-eyed stares and cruel jokes. Corrective plastic surgery was put off at least until the grade school years and by then the psychological damage could be severe. But today, kids in diapers are having their faces fixed up, some attaining normal or near normal features by the time they leave the crib. Others, the ones with the grotesque deformities, still may not be pretty, but the improvements are dramatic. A pioneer in the work is Dr. Linton A. Whitaker, a plastic surgeon at Children's Hospital of Philadelphia, the first institution in the country to embark on a fullscale program to repair facial defects in infants. It's accomplished in one procedure, combining neuro- surgery and craniofacial surgery — the restructuring and repositioning of such facial parts as foreheads, eye sockets, and noses. "As a resident, I was seeing all these children with dramatically deformed faces," Whitaker said in an interview. "Then I met Dr. Paul Tessier in Paris. He was just getting started in this whole field of craniofacial surgery. About that time (1971), it was felt the youngest you should operate was three or four years, and it was considered radical to do it before seven years." But as time passed, the 42- year-old plastic surgeon and his colleagues at Children's began toying with the idea of operating earlier. They reasoned that in most cases the neurosurgeon had to operate anyway, usually to relieve pressure ori the brain. ' Two scientific advances convinced them to try. "It used to be thought that there were growth centers around the face. If you operated too early you might destroy them and the face would stop growing." Whitaker said. "But after research with rhesus monkeys, it turns out you don't inhibit the growth process, and in some cases you may stimulate it. "Secondly, it's now possible through technical advancements, like reducing blood pressure during surgery, to lose less blood on the operating table. Support teams are now capable of caring for a child weighing. 10 pounds. Before there was a hesitancy to operate — especially when you consider there's a pint of blood in a 10-pound baby and you lose that much during the operation." Tessier spent several days at Children's Hospital teaching the refinements of craniofacial surgery. The first operation, in tandem with neurosurgery, was performed in 1972 by Dr. Peter Randall, chief plastic surgeon. In 1975, Whitaker operated on his first baby. Since then he has successfully operated on 42 infants, one only two weeks old. Whitaker, the father of three (his eldest son, Derek, 11, died June 12 during surgery to correct a heart defect), says the ideal age for craniofacial surgery is between three and six months. The babies normally are released from the hospital five to six days after the operation. "The self-image concept is developed about age 4," he said, "so the potential for avoiding psychological damage is quite real. Also, it's easier on the family. The older a child gets the harder it is to make the decision." Another advantage of operating so young, he noted, is that babies' bones are quite malleable. Consequently, it's usually possible to reshape the skull without grafting replacement bone from the ribs or hip, a painful procedure that's slow to heal. Also, babies bounce back from surgery quicker than older children. A drawback is that work often cannot be performed below the cheekbones for fear of damaging developing teeth. When Danny was a month old. the family's pediatrician referred the Brennans to Children's Hospital and the operation was suggested. "I was really scared," recalled Mrs. Brennan, mother of two other normal children. "Danny only weighed five pounds at birth, although he was a full-term baby. When they operated on May 4 (at six months) he weighed l"l pounds. I thought to myself, There's no way in the world this little baby is going to make it.'" An ear-to-ear incision was made across Danny's scalp and the skin pulled forward so Whitaker could repair the mis- hapen skull and align the eye sockets. Danny went home in a week. Recently he returned to the hospital for treatment of an eye infection. His hair was beginning to grow back, but the red scar was still visible. He slept in a stroller while his mother talked. "They say the Ivair will completely cover it," she said. "I can't believe the results. He's doing so good." She bent over her baby and smiled. A floor below in the operating room, Whitaker's hands were reshaping another infant's face, this time trying to make a little girl as pretty as modern medicine would allow. Almost half of the earth's population is packed into about five per cent of the earth's land mass, reports the Population Reference Bureau.