Surgery helps children face the world

By Catherine Masters

health reporter

It's not that easy to spot at a glance but little Peniahi Isoa was born with one half of her face smaller than the other.

Yesterday, in a first for the country, the three-year-old underwent a delicate new surgical procedure designed to outwit her abnormality and let her body grow new bone to make her face even.

Surgeons at Middlemore Hospital in South Auckland say a tiny device should lengthen Peniahi's facial bone to even up her face - and, all going well, she should be right in just eight weeks.

The new surgery should help hundreds of children born each year with facial defects such as cleft palate, which can lead to cruel taunting in the schoolyard and ongoing physical problems.

In yesterday's operation, plastic surgeon Tristan De Chalain implanted inside Peniahi's face a tiny metal device about the size of an adult's little finger.

It was locked on to the cut jaw-bone and will be slowly cranked apart over coming weeks to widen the gap between the bone ends.

The device stimulates soft tissue to grow and stretch as the body's own healing mechanism forms new bone to heal the man-made fracture.

Mr De Chalain said without surgery the pretty toddler's face would have looked extremely distorted.

The technique has in the past been extensively applied to the long bones of the leg and arm.

But recently it has been applied in the head and face and ever smaller devices are being developed for use in the skull and jaw for a variety of congenital abnormalities.

Without it Peniahi would have had two options - to wear a similar device but one which protrudes from the outside of her face, or to wait until she was a teenager to have her face cut open and reconstructed with the use of bones from other parts of her body.

Mr De Chalain said: "I'm planning to use this for children with congenital conditions and subsequent injury conditions where I need to be able to make more bone and I can't rely on just growth.

"Standard bone grafting techniques don't give you the results you want, so we're using this to move bones in new directions, if you will.

"We must have at least a dozen kids on our books who need this kind of surgery. I would think we're going to be doing at least one or two of these a month."

The results will seem like a miracle to Peniahi's mum Katea Isoa - "I want to make her face look pretty, cause she's a pretty little girl" - but Mr De Chalain says it is just a good application of basic principles developed through research.

"I think it's going to be a real boon to the work we do."

Pictured: Peniahi Iso. HERALD PICTURE / MARTIN SYKES