Thursday, June 5, 2014

Oh...hard things.



Isn't he beautiful...?

I tried to post the photos individually but instead had to take a screen shot. (Look at the first photo of his teeth on the top screen shot)

You can see a view of Azlan's top teeth.  So on the left of the photo is the cleft in his jaw bone. You can't really see the gap b/c it's filled with teeth. Two teeth. Only should be one, but there's an extra one in there. 

See the silver molar and the one behind it?  There are no adult molars coming behind those. They just are not there.  


This picture is really amazing. It shows not only the bone but also his face.  You can see the severity of his underbite. You can also see his screw implants in his skull.


This X-ray of his top teeth shows his baby teeth and the adults coming behind them.  Take a closer look b/c one of his front teeth is completely turned at a 90 degree.  




This one has a lot going on but if you look closely you can see some problems.  First of all, missing adult teeth...ones where just nothing is coming behind it.  Yes...this creates problems. We will be talking implants as we go.



His underbite. Oh how many of his speech issues are caused by this. It is so hard. So very hard...when your teeth are so far off and your jaw is so far off...it's nearly impossible to make so many of the sounds you need for clear speech. 


Here is the doctor's report:

 Orthodontic Diagnosis:    Class III malocclusion  
ICD9 code:   Unilateral cleft lip and palate 749.21 and Craniofacial microsomia 756.0

Face:    Asymmetry. Short facial proportions. Concave profile. 
Vertical:  8 mm overbite.  Short alveolar heights. Short R condyle
A-P: Class III primary molars and canines. negative overjet -10  mm, incisor crossbite
Transverse: Maxillary midlines 2 mm left of Mn.  Bilateral posterior crossbite resolves when A-P is corrected.
Arch Length: agenesis #4, #5, possibly #10 ? poor viability #7 ectopic in premaxilla.  Mild maxillary arch length deficiency. Mandibular arch length adequate
Radiographic: agenesis of teeth. Retrusive maxilla. Low mandibular plane angle.

Goal of treatment: manage eruption and space. Prepare for alveolar bone grafting
Suggested treatment: 
Mandibular lingual arch after #23 and #26 erupt – prevent overeruption of mandibular anterior teeth
Extract #D, #D-supernumerary, #E, #F, #7 tooth bud – Dr. Rusty Walker
Alveolar bone graft Dr. Gruss – in advance of central incisor eruption – summer 2014
Consider maxillary alignment after engraftment confirmed – separate code and fee
Monitor growth and eruption with serial radiographs
Consider Maxillary distraction when eruption of permanent canines is favorable


Ok.  So what does it all mean?  Well...it's tough.  Things are not looking good in his mouth.  He has a "class 3" cleft...and that means it's extreme. In comparison, Zihao and Taizi are class 1.  

The big surgery ahead of him is done just before adult eye teeth come in.  Zion is almost 9 and his baby eye teeth are still solid. So it's between 9-10-11 years. Azlan is 7.  We were told today he has to have this big surgery this summer.  Yes. This summer. September at the latest. His mouth is so complex and he just had his adult front tooth (the good one!) come in...WAY behind his baby tooth. Way behind.  His baby teeth are rock solid. There is nothing pushing them out. With that, the other tooth that is turned at 90 degrees...will end up somewhere mid palate. :( This is very sad to me...b/c of speech.  When your teeth are your marker...for where to place your tongue... :(


First step is he needs surgery to remove his front teeth.  All 4 of them.  Then 8 weeks later he has his major surgery with the bone graft from his hip to his jaw.  

It's sad on many fronts. It's been hard for Azlan.  His teeth coming in where they are with all the other problems he has in his mouth...it's a big set back and it wasn't anticipated.  This surgery NOW...?

All day I've been a breath away from tears. Lots of tears.  

The best moment of the day was when I hung up the phone from the consult with the DR and I held Nazara and went outside for fresh air. Yes. I needed it.  I started singing to her and she laid on my shoulder. I always sing Jesus Loves Me. That's what I sing to my babies. Always. I was mid song and realized I was not singing that. I stopped and started to smile. I love how God works. I was singing "never once have we ever walked alone...never once have you left us on our own..."

I needed that moment all day long.

I sat down with all the children and told them what was happening. It was really special. Tirzah was teary. Chazano was saying how sad he was for Azlan.  Azlan was just staring at me. I could tell he was reading me pretty intently.  I said it's going to be hard.  This isn't going to be fun. It's much much sooner than we anticipated. Speech is going to be harder.  But ... 

Always a "...but..."

We will work harder.  Love more.  Listen more carefully.  Be more patient.  Be kinder.  Be more understanding.  We will be more diligent.  We will never give up. 

We will...overcome.

Azlan...will overcome.

And you know it...the end result will be that much sweeter.

To the child that changed the rest of my life. Azlan Honor. I adore you.  

This is our family's theme song:






2 comments:

  1. Oh my Janice :( That's a l ot to handle for a 7 year old to handle. Much less your whole family. You are a family of overcomers :) That is for sure. I couldn't even process all of what was wrong there..I understand the no adult teeth though! I am missing 4 so I feel that part of his pain...I will be praying for him this summer!

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