/beth

[Guest guest]

Dear ,

Sorry I haven't got back to you earlier

but I have had two deaths in the same week. One, a family member

and the other a good friend. So as you would understand I

have been focussed elsewhere.

I have been in contact with the orthodonist that is treating

lise and he is happy to email you more information about

bite plates and treating HFM. Do you mind if I forward your email

address to him?

Thank you for the www.craniofaciaal.com/isoc.html site

I checked the site and the au doctors listed don't perform

auricular reconstruction. I have received a response from

Dr and included it for your perusal. Is this similar

to the information that you have.

At the Australian Craniofacial Unit we manage children with

hemifacial microsomia according to an 18 year protocol and have

published our work and results over the years and particular

reference to the classification. Whilst I am aware that you are at

the moment focussed on techniques for ear reconstruction, we usually

advise that this is fitted in to the whole protocol management as

hemifacial microsomia is a dynamic condition which continues

throughout the growth period of the child and what today is only

slight, tomorrow becomes more obvious. We believe that it is

important to have a multidisciplinary approach to this condition and

in this context believe that the external ear reconstruction should

not be attempted until growth is complete as we have seen many

examples of quite reasonably reconstructed ears that are

malpositioned after the final growth spurt has taken place. With

respect to techniques, as I am sure you would know, there are the

autogenous material techniques as practised by Dr Brent and Francois

Firmin. These are wonderful practitioners of ear reconstruction but

even they can produce results that are not acceptable to some

people. The down side of this type of surgery is that even when the

result is good there is significant chest scarring and the procedure

is multi staged. The alternative principle is to have an

osseointegrated implant and artificial ear and thirdly to have no

reconstruction at all. I do not personally perform this surgery but

we have members of our team here in Adelaide who do. We are able to

provide photographs and we are able to put you in touch with families

who have had various forms of ear reconstruction and who have had the

long-term management of hemifacial microsomia. With respect to the

likelihood of creating an ear that is reasonable, I believe that this

is probably less than 50% and even when it is, in the autogenous

setting, the body scars are a significant downside. The worse case

scenario is that the child undergoes multiple stages in an attempt to

make an ear. This fails, leaving a very ugly or failed attempt plus

the associated body scars. Should you wish to travel to Adelaide to

see us and further discuss your child's management we would be happy

to accommodate you.

I would value comments on this information.

I have looked at the photo of Brogan. He is adorable. His

HFM is similar to lise's. A friend who has a digital

camera has offered to take photo's of lise and I will send you

some.

Take care

WEndy