London Free Press - Local News

The = Engineer

Sat, June=20 16, 2007

Damir Matic=20 turned his back on tradition and chose medicine over = engineering. On=20 this day in the operating room, though, a familial skill = helps the=20 doctor rebuild a little girl's jaw.

By JOHN MINER, SUN=20 MEDIA

On the stretcher outside the Victoria Hospital operating room, = the=20 eight-year-old girl clutches her stuffed dog and listens to the=20 reassurances of plastic surgeon Dr. Damir Matic.

There are a few tears. She has been through this before.

"It won't be like the last one. It will be better," Matic tells = her.=20

Applying surgical skills to children is what enticed Matic to = move to=20 London from Toronto. He's one of only a few craniofacial surgeons = in=20 Canada -- surgeons who correct deformities in children.

Besides helping kids, Matic says, the surgery appeals to his = creative=20 nature.

"They are complicated. It is not just putting the jigsaw back = together,=20 it's recreating the jigsaw and then putting it together."

And unlike in adults, a plastic surgeon operating on a child = has to=20 take into account future growth -- what they'll look like years = ahead as=20 their body fully develops.

Matic's practice is 75 per cent children and 25 per cent = adults, with=20 most of the adults being involved in car crashes.

"The challenge in the adult perspective is the guy who comes = home, sees=20 his wife with another guy and decides to take a shotgun and kill = himself.=20 He blows his face off, but doesn't kill himself. Those are very=20 challenging people to put back together."

Today, Matic's first challenge is the girl with the stuffed = dog. She=20 was born with Treacher Collins Syndrome, a genetic defect that = results in=20 a small lower jaw -- actor Sylvester Stallone has it.

The girl has a severe form of the defect. She was born with a = small=20 jaw, no cheek bones and an unusual skull. In four operations, = Matic has=20 rebuilt her skull, used bone from her ribs to give her cheek = bones,=20 reconstructed a missing eyelid and lengthened her jaw.

But because of her small jaw, there isn't enough room for her = to=20 breathe through her mouth because her tongue is in the way. = Instead, she=20 has to breathe through a tracheostomy, an artificial opening in = her neck.=20

The plan is to lengthen her jaw again by breaking the bones and = attaching rods that protrude through incisions on each side or her = face.=20 By turning a screw at the bottom once in the morning and once at = night,=20 her jaw will extend one millimetre a day. As the rods pull the jaw = bones=20 apart, new bone grows to fill in the gap.

'We are kind of tricking the body into growing new bone," Matic = says.=20

When the process is finished in about three months, the rods = will be=20 removed and the girl should be able to breathe through her mouth. =

In the operating room, as the nurses and anesthesiologists make = final=20 preparations, Matic studies 3-D images of the child's head on a = screen,=20 weighing where to make the cuts to break the jaw bones.

"There is a little bit of engineering here. Even though I = wanted to=20 escape engineering, I still have to do it," says Matic, whose = father,=20 mother and uncles were engineers.

"We are going to do an oblique, almost horizontal cut through = the jaw,=20 hopefully having enough bone to put two screws on either side." =

The challenge is there is only a tiny space to work inside the = girl's=20 mouth.

Assisting Matic is Dr. Toni Zhong, chief resident.

At 8:35 a.m., they start what should be a 3 1/2 -hour = operation, sewing=20 a stitch through each eyelid to keep them closed, protecting the = eyes.=20

Looking on is Blaine Prentice, with a set of surgical = instruments=20 matching those Matic and Zhong are working with. Prentice is with = the=20 company that supplies the hardware used in the operation.

Except for the regular beeping of the heart monitor, it's quiet = in the=20 room as Matic checks how he'll install the rods -- called = distractors --=20 in the child's mouth.

As he works to fit the first one in place, there's a growing=20 frustration in his voice.

"There is not enough space. It is too tight. There is not = enough give=20 in her face," Matic tells Prentice.

Ninety minutes into the operation, there's a steady = conversation=20 between Matic and Prentice over how the rods can be made to fit. = Holes=20 have been drilled in the jaw to take the screws that will hold the = distractor in place.

"These screws aren't crested. They are falling out," Matic says = with=20 exasperation.

Prentice suggests using other screws that aren't the same metal = as the=20 rods, which would be ruled out if the hardware was permanent. But = with it=20 being taken out in three months, it's an option.

Matic and Zhong continue the struggle to install the rod.

"There are just too many variables here," Matic says, shaking = his head.=20

Quietly, he tells the operating room team he may have to give = up.

"I'm going to give it another 10 minutes and if it doesn't = work, we're=20 abandoning, because it's not the right thing to do for this little = girl."=20

If he does make the call to quit, it will mean a long walk down = the=20 hall to the child's waiting parents to tell them it couldn't be = done.

One option will be to call it a day and try another time to = perform a=20 different type of operation, one in which rods are installed on = the=20 exterior of the head. But the child had that done when she was = four and=20 has said she doesn't want to deal with that again.

The other is to give up on trying to surgically correct the = deformity.=20

As Matic and Zhong -- one on either side of the child's head -- = continue their efforts, Prentice confides this is one of the more=20 difficult procedures.

"Matic is a first-class surgeon, but this is really a tough = operation,"=20 he says.

Seconds away from his self-imposed deadline, Matic gets the = first screw=20 firmly in place. The rest follow in relatively short order.

As the remaining hardware is installed, Matic says he dreads = taking it=20 all back out in three months with the same problems. What he would = really=20 like is a right-angled screwdriver -- if there was such a thing -- = he=20 could use in the confined space.

Prentice says his company recently developed such an = instrument.

"Get me one," Matic says.

Prentice goes to work on his Blackberry. Later, he announces he = has=20 reserved one of the screwdrivers for Matic.

It will be delivered before the next operation.

---

It's noon when Matic is finally able to walk out of the = operating room,=20 but he's skipping lunch to brief the child's parents and see his = next=20 surgery patient, a man who had his cheek bone broken a couple of = years=20 before.

"I always end up operating on the guy who was just sitting = there=20 quietly when someone came up and took a swing at him. I don't know = who=20 takes care of the ones who start the fight," Matic says.

In this case, he repaired the man's face two years ago and the = results=20 were nearly perfect. But not perfect enough for the man's = girlfriend, who=20 said she could see one cheek bone was lower than the other.

"I told him I don't operate for girlfriends, that I wouldn't = operate=20 unless it was for him. He called back, said he had really thought = about=20 it, looked in the mirror, and (noticed) it is a little off."

To Matic, the surgery is close to crossing the line between one = that is=20 medically necessary and cosmetic surgery.

But OHIP approved it so it will go ahead.

The operation involves screwing a piece of porous polyethylene = plastic=20 onto the damaged cheek bone to raise it the couple of millimetres = needed=20 to precisely match the other side. In time, the man's blood = vessels will=20 grow through the plastic, making it part of his face.

To get to the cheek bone, Matic makes an incision through the = inside of=20 the man's mouth. He unscrews and removes the plate he had = originally=20 installed to hold the cheekbone in place. Then he slides the = polyethylene=20 disc in place. Matic and Zhong inspect the man's face.

Now the one cheek is slightly higher than the other.

Matic fishes the plastic back out and starts shaving it with a = scalpel.=20

Although he's a plastic surgeon, a term used because the = physician=20 reshapes body tissue, this is the only time he actually works with = plastic.

Slid back in place, the cheek bones are now a match that even a = girlfriend could love.

---

The final operation is another cheek bone repair, again a guy = who was=20 minding his business when someone took a swing at him.

What should be a 10-minute procedure turns into an hour.

"Theoretically, he could wake up blind.

"Do you think people would think twice about getting in a fight = if they=20 knew what they had to go through?" Matic asks.

News Headlines

'We=20 are on the cusp of a revolution in surgery.'
Zaccardelli=20 slammed for RCMP bungling
Hundreds=20 of new lots could be unleashed
More=20 letters than ever
Big=20 cats loom large - in print
A=20 force divided
Cosmonauts=20 get computers running
Bush=20 cash cow despite approval rating
Halifax=20 protest turns ugly
Girl's=20 appearance startles searchers
U.S.=20 fighter jet crashes in Iraq
Rushdie=20 named a knight
Passport=20 rule delay a boost for Canadians
Critters=20 invade parliamentary offices
Dion=20 claims early victory
Aging=20 boomers start to spell lower economic growth
The = Engineer
In=20 the O.R.
International=20 Day of African Child celebrations mark child trafficking
Raid=20 may lead to murder weapon
Police=20 leak alleged in Toronto raids
Hamas=20 offers beaten Fatah rivals amnesty

BREAKING NATIONAL &=20 INTERNATIONAL NEWS

= Mideast=20 summit to take place Monday: Israel
LONDON = (AP) -=20 Prince William turned 25 Thursday and now has access = to part=20 of the inheritance left him by his mother.
FUL= L=20 STORY More at = CNEWS

	14 = U.S. troops killed in Iraq
	Ag= ent=20 Orange report minimizes health risk at N.B.=20 base
	Sea= rch=20 for missing kid leads to Wis. house of = horrors
	G= atineau=20 cop nabbed in big cocaine=20 = bust


=20 Thursday, 21 June, 2007	Subscribe=20	News = Research=20 Centre	Place a Classified Ad=20	Advertise=20


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