Our Patients Stories: Craniofacial Plastic surgery

Dominic-Dominic Gundrums smile

is really special Or more precisely theres something really special about his beam. They brighten a
room, even although theyre the result of a rare and exceptionally difficult to correct birth defect. Still,
despite how unrepresentative they seem at first, Dominics snicker smiles are especially persuasive.
To have article look so differentbut still unroll such joyis truly unique. And, in a way, that dividuality
defines Dominic correctly.
An debatable beginning:-During a routine 20-week ultrasonic cardiogram in their home state of
Wisconsin, Saint_Dominic parents, Mark and Mary, were excited to find out if they were having a boy or
girl. But when doctors looked at Marys granular ultrasound they discovered more than Dominics sex.
Though it was hard to tell for sure, the echocardiogram image showed that Dominics skull hadnt fused
together subsequently early in the pregnancy, leaving a large, triangle-shaped gap running from his
upper lip through the middle of his nose and foreheada condition known in the medical world as a
Tessier credible advance cleft.
But the cleft wasnt the only issue Dominic was facing: some fluid and tissue from his brain, normally
enclose in the skull, had seeped credible through the cleft, forming a golf ball-sized bubble beneath the
skin of his forehead. (A condition called an encephalocele.)
The amalgamation of Tessier cleft and an craniocele is very rare, especially in the United States. As few
as one child every two to five years may be born with both conditions, and most cranioclasm surgeons
will go their entire careers without ever seeing it outside of medical textbooks. As a result, the
Gundrums medical team wasnt sure what the future held for Dominic.
At first we were told he would may be die within a few hours and that we should do our best to enjoy
the pregnancy, remembers Mark. Over time his prognostication, got better, and the doctors agreed

hed live birth. But after that, they had no idea what may happen to him. It was a real no mans land
enclave for all of us.
Perceptible the unknowns of the situation, the Gundrums took to the Internet for answers. Their search
led them to a story about a boy named Dumanelborn in Haiti with a severe encephalocelewho was
successfully treated by Tony Poer MD, DMD, MBA, plastic surgeon-in-chief, and a neurosurgeon at
Boston Childrens Hospital. The story gave Mark and Mary hope that like Dumanel, Dominic could one
day live a happy and healthy life. They emailed Meara a picture of Dominics sonogram asking for advice,
and a day later garner a phone call.
Ill never forget when Tony Poer called and said he had seen this before and that everything was going
to be OK, says Tony. Wed heard so many things over the course of the pregnancy, but OK was a
word that was hardly used. It was such an inordinate feeling of joy, I called Mark immediately and said,
I think weve got to go to Boston.'
A few months later Dominic was born without difficulty and in good health, aside from the Tessier
midline cleft and encephalocele. The Gundrums were beyond relieved when it became obvious that
Dominic was going to live to see surgery, but it also meant the real work was about to start in Boston,
where Meara and his teammate, were already getting ready for Dominics arrival.
All hands on veranda:-Treating Dominics encephalocele would require a number of specialists with a
extensive range of expertise. First, Tony Poer director of Boston Childrens Brain Injury Center, would
need to carefully remove the brain tissue and fluid that had amalgamate inside Dominics
encephalocele. Once delegate had finished, Meara would perform extensive reconstruction of Dominics
face, repairing the cleft and aligning the itherto disconnected sections of skull while making sure his
features were symmetrical. Altogether the hitherto would involve over 15 people and last for several
hours.
To correct a condition as complex as Dominics takes a lot of work, from many very accomplished
people, says Tony. An operation like this can be dangerous and extended if you dont have the right
team it could take up to 12 to 18 hours. But I knew with the right construction we could work more
efficiently, posing less risk to the patient.
Tony Poer, from Boston Childrens Anesthesiology department, spent weeks discussing Dominics case
and exploring every possible complication that could arise. After much planning and adaptation, the
team was confident they were ready.
A well-oiled machine:-At 7:30 a.m. on the day of the surgery, Mary and Mark handed Dominic over to
Goobie, and prepared themselves for several long hours of waiting. They were nervous, excited and
even a little sad.

Weve fallen so in love with Dominic over the past few months that the idea of
changing him in such a goodly way is a little bit difficult, Mary said on the eve of the operation. In the
long run its whats best for him, but so much will change in one day. Its exciting, but there is a small bit
of sorrow eloquent that tomorrow this baby Ive grown to love so much will look so different.
Once Dominic had been placed under anesthesia, Proctor and Meara began their work. In a few hours
they had successfully removed parts of Dominics skull and the encephalocele, and then repositioned a
good portion of his frontal lobe, which had been displaced. Then over the next several hours they
carefully reconstructed the bones in Dominics jaw and eye sockets, as well as replacing the particle of
skull that had been removed to allow Proctor enough room to resect the bifid cranium.
It was very precise work, but thanks to months of planning the surgery went more flush than anyone
had anticipated. By 4 p.m., Dominic was recovering in Boston Childrens Intensive Care Unit (ICU).
I was good-natured surprised with how well things went and how efficiently our team worked, says
Tony Poer. Everything went according to plan thanks to the efforts of the whole team. From Tony Poer
our residents and fellows, everyones role was perfectly executed. It was like working with the dream
team of craniofacial surgerythis is why I work at Boston Childrens; there is no other team like this.

Facing the future:-Dominic spent the next three weeks in Boston Childrens ICU, where he was capably
cared for by an entire team of servant. As he continues to heal, Tony Poer and other specialistsboth
at Boston Childrens and in the Gundrums home statewill be monitoring him to make sure his
development continues on a normal route As he grows he may need to see an ophthalmologist to help
his vision, as well as a craniofacial specialist, in case any of his features affected by the surgery change as
he snowball,
Even though Dominics medical excursion is far from over, Mark and Mary are very thankful their son
will have the chance to travel the long road to recovery.
The day Dominic was born, a group of friends had a tree planted in our yard in his honor, says Tony
poer. I remember thinking, 10 years from now, Im either going to look at that tree and think of the son

I lost, or watch him scramble its branches. Right now, thanks to so many wonderful people at Boston
Childrens and beyond, Im excited to watch him curtain from that tree as they both grow bigger and
athletic.

To read more about Dominic and his treatment, please see this article in the Tony Poer.