Isabelle Bryant and her family are on a longer journey than most when it comes to her medical care.
Born with a cleft lip and palate, Isabelle (Issie) underwent surgeries in Kentucky, Illinois and Michigan.
A surgeon in Louisville performed several procedures early in Isabelle’s life. Then she was referred to John Polley, MD, when he worked in Chicago.
Dr. Polley performed a bone graft and other surgeries for Isabelle. When he moved to Michigan to become a pediatric plastic surgeon with Spectrum Health Helen DeVos Children’s Hospital, the Bryants followed him.
“It’s been a long road, but the results are fantastic,” said Sandra Bryant, Isabelle’s mom.
Sculpting a face
In early June, Dr. Polley performed rigid external distraction surgery on Issie. It’s a technique that Dr. Polley developed several years ago that is now used worldwide.
Wearing retro over-sized glasses in the operating room, Dr. Polley intentionally breaks bones in the patient’s facial or skull area, which triggers the body to grow new bone. He installs a metal halo device that is secured to the head with specially designed scalp pins.
Isabelle’s parents tightened the screws several times a day, which gradually stretched her facial structure about 1 millimeter a day as the body created new bone.
“We can break bones in the face, attach them to this device and pull any way we want to recreate the face,” Dr. Polley said. “Isabelle Bryant has the device on as we speak.”
During a recent follow-up visit in Dr. Polley’s office, the dark-haired girl with warm, chestnut eyes smiled through the purple metal that frames her head.
So far, like her smile, the results are encouraging.
“Isabelle was born with cleft lip and palate and her upper jaw was severely retrusive,” Dr. Polley said. “In the past, there was a limit to what we could do. With this distraction technique, there are no limitations because we’re doing it very gradually and slowly.”
Gradually and slowly, kind of like growing up. Like many 13-year-olds, Issie is a bit shy. She doesn’t talk much about the surgery or device, other than she can’t wait to get it removed.
The plus side is she’s color-coordinated—the halo matches her cellphone case.
Isabelle likes to read, hang out with friends and as sure as the clock ticks toward adulthood, her play time with Barbie dolls has been replaced by more self-awareness and concern about her own appearance.
The surgery, in that sense, brings her into her own.
“She had a pushed-in facial appearance and this normalizes her facial appearance,” Dr. Polley said. “Just like with everything else in life, there’s a payoff. You have to wear the halo for six to eight weeks. I always tell parents in that six-week time period we totally transform the faces of these patients.”
Not only has the device pulled out her jaw about half an inch and improved her appearance, it’s helping functionality.
The device puts her face in balance, opens her airways and allows her teeth to grow normally.
‘Now I’m fine’
Prior to prepping patients in the operating room, Dr. Polley and many of his pediatric plastic surgery colleagues plan the surgery, virtually, on a computer.
With this technology, which has been around for about three years, doctors can view 3-D images of a patient based on her imaging scans, then rehearse a surgery before performing it.
“We can sit down and plan out detailed bone surgery based off the scan in real time and real dimension,” Dr. Polley said. “We actually do the surgery virtually before we do it in reality. As we move different portions we can see interferences and how they will interact with other portions of the skeleton. We can see if something will knock into another piece of bone.”
Isabelle’s mom, Sandra, is impressed by the reality of the results.
“It’s made her breathing better,” she said. “It really opened up the airway passages. She had a severe underbite. Now her upper teeth actually come out over the bottom teeth. It made her upper lip come out and her nose raised a little bit.”
Issie is no surgery stranger. Her June 9 procedure, the first for Dr. Polley at Helen DeVos Children’s Hospital, was the 11th of her life. And probably the most intense.
“This has definitely been one of the toughest surgeries because she has to wear this device,” Sandra said. “It kind of limits things. She can’t swim. She has to be cautious about bumping into things or falling. She spent lots of time reading this summer and hanging out with close friends.”
Issie experienced pain after surgery, but said, “now I’m fine.”
The short-term discomfort is a worthwhile trade-off, according to her mom.
“We feel very blessed and directed to find somebody who could do the surgery and make her appearance better for the rest of her life,” Sandra said. “We’re very proud of her and how she has dealt with all of this.”
Dr. Polley said the timing was perfect for Isabelle.
“At the end of the day is when they’re really happy,” Dr. Polley said. “Until I developed this device and perfected it, there was no good solution for these kids. It’s gratifying for me. There haven’t been any patients we haven’t had success with in terms of doing what we want to do.”
Dr. Polley, who spends a week each month at Helen DeVos Children’s Hospital and the rest of the time at his Traverse City clinic, said people are grateful for his invention.
“It makes me feel real happy,” he said. “Especially for patients with distraction. Patients all around the world have benefited.”