a new challenge... part 2

Let me start "Part 2" by saying that as a follow up to my previous post, I really am in an okay place with this... it just generally sucks. I know that there are other families who go through oh-so-much more. They have far more devastating things with which to deal. So know that I am not complaining, but I am just sharing how I genuinely feel.

The basic growth pattern for a child's face is that the lower jaw grows down and forward, then the upper portion of the skull follows, down and forward. Since Beebo's lower jaw on the left is not growing adequately, the upper portion of his skull cannot grow adequately either (even though it has the ability to do so). So, basically, the entire left side of his face is staying the same size while the right side grows... hence, the more noticeable changes to the structure of his face over the last year or so. 

Like I said before, it's hard to predict the future, but a basic plan of action for Beebo is this:

• This summer, we will remove at least one impacted molar. His "6 year" molar on the lower left has not erupted, because it can't - it's trapped under his "12 year" molar. We need to sacrifice at a minimum the "12 year" molar to see if the "6 year" will come in. We may need to sacrifice both of them, but we won't know until the oral surgeon gets in there. 
• Once the molars are out of there, the mandible can fill in with bone and give us a more solid, stable place to affix any type of treatment. We'll wait 6 months for it to fill in completely with bone after the extraction.
• In March, we'll go back to Iowa and get a third Cone Beam CT Scan. This will give the doctor several scans over a 15 month period to assess how much growth is happening on the left side of the face. 
• Next summer (2014) at age 9, the plan is to do a rib graft surgery to replace the deformed/missing portion of his condyle and mandible. They will remove either his 5th or 7th rib on the right side, shape it, and secure it onto the mandible. His jaw will be splinted and then wired shut for about 3 weeks. The hope is that the rib will continue to grow, allowing the upper face to grow as well, slowing down or, best case scenario, stopping the rate of deformity.
• Braces will follow, somewhere around age 12. 
• IF the graft does not grow significantly or enough, he will be facing another surgery around age 15 - a mandibular distraction. His mandible will be separated into 2 pieces, then a distraction device will be secured to it and the split will be slowly increased over the course of a couple weeks. When it is in the right place, it will be secured and new bone will fill in the gap. This process takes about 3 months. 
• IF, when he is finished growing around age 19, he is not happy with his appearance, he can opt for a final orthognathic surgery. This surgery would be pretty much cosmetic in nature and this will be his choice.