Rare surgery fixes toddler's jaw

Angela Bhandari had her jaw surgically extended. Photo / Greg Bowker

Little Angela is rewarded with much improved health after enduring months of operations and pain.

Every morning, Angela Bhandari's surgeon used a special screwdriver to unscrew her jaw a little bit.

As a baby, Angela's mouth was almost locked shut by an infection and doctors needed to regrow the bones in her face.

In a rare procedure, Angela, of Mt Eden in Auckland, had her jaw surgically extended.

Now aged 2, she couldn't eat solid food for several months. Her jaw had stopped growing because of the infection. Her doctor couldn't even get a "say aah" stick into her mouth.

She was restricted to purees and other soft food and was underweight. Her breathing was so bad that a tracheostomy tube had to be placed in her neck.

But the bright toddler's biggest eating woes are over and the breathing tube has been removed.

The lower jaw bone extension was done in 2013 with "distractors", one placed under the skin on each side. The expanding metal devices were screwed on and the bone was cut right through between each device's two mounting plates. Thin control rods protruding through the skin behind her ears were turned with a special screwdriver, drawing the bone ends slightly apart, once a day for 20 days, allowing new bone to grow in the gaps.

Angela was taken to Kidz First at Middlemore Hospital every morning for the rotation of the distractors. She was given Brufen to help dull the pain that occurred during and slightly after the movements.

After the 20 days, the control rods were withdrawn and the rest of the distractors left in place for six weeks for the new bone to consolidate, then removed.

In subsequent surgery, new jaw hinges were made using two of Angela's ribs, as her natural ones had fused rigid with bone ingrowth. The replacements were held in place with tiny metal plates and screws until they had stabilised enough for the metalwork to be removed by Angela's plastic and reconstructive surgeon Dr Jonathan Wheeler last month.

Angela's mother, Hima Bhandari, said she and Angela's father, Hari, both originally from Nepal, are very happy with the operations.

"The first operation makes her pretty. The second operation makes her eat properly," said Mrs Bhandari.

Angela had a staphylococcus aureus infection in her right elbow when she was 15 days old. The cause is not known but it is thought the infection spread to her jaw.

Dr Wheeler said Angela's jaw still had some restriction and she would need further surgery, hopefully when she was fully grown. Jaw distractions were not common, he said. No more than three patients had the treatment each year at Middlemore.