Saturday, April 12, 2014

Premaxillary Repositioning Tightening

After little Walnut had his surgery to place the prosthetic prosthesis with the premaxillary repositioning and NAM device we were scheduled to revisit the hospital every other week to have the chain tightened.

When I called the doctor's office they scheduled the first tightening for three weeks from his surgery, and although I put it in my calendar as such, I somehow had it in my head that he was scheduled two weeks after the surgery. Long story short, I realized on the way up to Salt Lake that we were heading up a week early.

I called the office to be sure, and sure enough we weren't supposed to go up until the next week. Classic. Since we were already on our way, they told us to come up anyway and they'd squeeze us in. And naturally, I forgot to schedule an appointment with Dr. Yamashiro, the pediatric orthodontist, as well. His office was also extremely accommodating, and told us we could come up after our appointment with Dr. Morales.

Once we were in the exam room I took Walt out of his car seat and swaddled him up. Dr. Morales was out of town, so his associate, Dr. Morris (an ENT), was taking his appointments; she was in the operating room for Walt's surgery as well.

She had me hold Walt in my lap with his head facing her. Among the squirming and screaming from Walt while I held him down and a nurse's assistant held his head, Dr. Morris managed to locate the hook on the left side of his mouth and move the chain over two links.

I also told her that a few days earlier Walt had gotten out of his no-no's in the car, and hooked his finger in his nose wire and yanked it down a little. She tried her best to work on his wire to push it back up into his nose, and move it away from his gum line, but it proved to be a little harder than expected. It wasn't quite bending like she'd hoped, and after awhile of working on it, she decided not to bend it anymore in fear that it would weaken and break. She said Dr. Morales would look at it at his following appointment and see if it needed any more adjusting. She also said she remembered them commenting on the length of the wire in the OR, that Dr. Yamashiro had made it a little long, so they really wouldn't be able to move it out of his gum line entirely.

It was extremely unpleasant watching him go through that, and there were brief seconds where I thought I couldn't do it anymore and considered telling my mom to take Walt and I'd wait in the hall. I pushed past it though because I'm Walt's mom, and he needs me.

I held little screaming Walt as we went up to the pediatric orthodontist afterward, and my mom readied his bottle. I was met at the front desk of the orthodontist by a mom and her daughter. As soon as we walked in, she turned and glanced at us and gave a small gasp. The hygienist asked her, "did you just have a flashback?" This sweet mom started fanning herself with a piece of paper as her eyes started to well up. Her teenage daughter had also been born with a cleft lip and palate, and here we were practically reenacting similar scenes from her life years ago.

She looked at Walt and commented that her daughter had the same device, and was fed by the same bottle as well. It was pretty neat to talk with her for a minute and be reminded that thousands of others walk this same path. She was very sweet, as was her daughter, and they both assured me that she doesn't remember any of what we are watching Walt go through.

Dr. Yamashiro took us right back to his office, and looked at the prosthesis quickly to ensure everything was in it's right place, which it was, and then we were free to go.

Walt spent the rest of the day pretty irritable, and on a steady regimen of Tylenol.

We've had two other tightening appointments since, and both times Dr. Morales has decided that the chain still has enough tension that there's no need to tighten it. At the appointment two weeks after the first, I asked about the divot the nose wire has made in his bottom gum line, and could it be moved at all. He messed with it a bit, and pushed it even further into his nose, which lifted it a little from his gums.

For the next week Walt's nose was clearly sore, and he would get upset any time we touched it. It looked pretty red and shiny from being stretched tight. Since Dr. Morales hadn't tightened his chain, he had us come in a week later, which luckily for us was at their clinic in Provo.

He noted that his right gum line had started to drop down a little from the chain slipping, and said that once again the chain was still tight enough, and by the looks of his drooping gum line if he were to tighten it again it could rip through his gum line. That could happen as well even if the chain wasn't slipping, just by putting too much tension on the chain.

I asked about his nose as well, and he said he had probably pushed it up a little too high, and adjusted it again. This elicited a lot of crying just as it had every time they messed with it. Oddly enough, the part of his device that has been the least invasive, has caused the most trouble for him during his appointments. Poor little fella.

Dr. Morales said no more tightening was needed, and that he wouldn't see us again until his surgery on May 6th. Apparently once he closes up his lip, his gum line will move together much quicker than it has since he put the appliance in, since the lip tissue is stronger than the rubber chain. He said once his lip has healed up enough for us to lift it and look inside his mouth, that we'll see his gum line nearly touching by that point. Just in a matter of weeks. Wild!

Since he didn't need us to come again, he cut the black stitch off, and removed it from Walt's mouth. It was there just for leverage when he tightened; to move his lip out of the way while he was trying to locate the chain. There was no longer a need for it.

So now we are stitch free, and on a break from doctor's visits until the big surgery day in a little over three weeks. I'll get to my feelings on that day in a later post. I'm NOT looking forward to the surgery at all, and not for obvious reasons.


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