Juliana is now Three
Juliana Wetmore is now three years old. She has undergone 20 plastic surgery operations to try and rebuild her face and now faces the 21st and perhaps most serious operating procedure yet.
Thom Wetmore says of his daughter “Every single day, I come home from work and she has done something to make me smile”.
Juliana will undergo another major surgical procedure to dramatically alter her face. This time by a process called ‘distraction’, the surgeons will attempt to bring her entire lower jaw several inches forward. This procedure had been attempted previously, in 2004, but 2 weeks into her recovery, the metal bars used to spread, or distract, the jaw, began pushing up into Juliana’s eye sockets. The pressure threatened to leave her completely blind and the bars had to be removed.
Dr. S. Anthony Wolfe, Chief of Plastic and Reconstructive Surgery at Miami Children’s Hospital, has been treating Juliana since she was three weeks old. A year on from her last surgery, Juliana has grown, her bones are thicker and Dr. Wolfe has decided that the time is right to revisit this procedure.
He explains the procedure “If we can get the mandible much larger, the tongue will come forward with it and it is hoped that this will allow her tongue to rest, naturally, in her mouth.
March 2011: There is hope for Juliana Wetmore, A check on her web site reveals that she was attending a regular 3rd grade class in school.
The surgery is only one part of a complicated care regimen. Juliana cannot swallow food or drink as she has no movement of her jaw. Instead she is fed through a tube connected to a valve in her stomach called a Mickey Button. Also, she cannot breathe properly on her own because of the abnormal tissue and bone structure. She breathes through a tracheotomy valve inserted into her throat. This demands constant attention and care to keep it unblocked.
Juliana will undergo two days of testing, a CT Scan and a full evaluation from the doctors on the cranial-facial team at Miami Children’s Hospital in preparation for her procedure.
Dr. Mislen Bauer, Director of Clinical Genetics, observes “She’s a very bright little girl, this condition that Juliana has, Treacher Collins, does not affect the brain”.
Dr. Silvio Podda, Plastic and Reconstructive Surgeon, comments “Our first priority is function. At this point, what we’re trying to do is reconstruct the foundation of the face. Later, once we are able to improve the function, we’ll probably go to a second phase, which will be to create a more aesthetically pleasing face”.
The tubes in Juliana’s nose are used to create nasal passages. Dr. Wolfe changes these often, increasing their width to gradually increase the size of the nostrils.
After seeing the CT Scan, Dr. Wolfe’s plans change. Because Juliana has a full set of teeth along the lower jaw, the distraction process would split the teeth leaving useless teeth high up the bone where the ramus should be. He would now prefer to use bone from her ribs to graft a ramus. The risk is great, but if Dr. Wolfe can successfully move Julianna’s jaw forward so her tongue rests more inside her mouth, it will be a major milestone on the road to a functional face.
After seven hours in the operating theatre, Juliana is moved to Intensive Care. The operation is a success, but now the long and uncertain recovery begins. Kendra, Juliana’s five year old sister has been by her little sister’s side through all of her major operations.
Part of the greater goal is for Juliana to be accepted into society. Thom and Tami have never hidden Juliana away, but if she is ever to be fully accepted into her community, it is crucial that she is accepted by other children. But, the schoolyard can be a cruel place.
Tami takes Juliana to a Mother’s Day Tea at Kendra’s school. Tami hopes that by exposing her to other children, gradually, now; she will have an easier time in adapting when it’s her turn to go it alone.
The Jacksonville community have been a huge support for the Wetmore family with regular fund-raising events for Juliana’s charity. The Annual Chrome Divas motorcycle rally has raised thousands of dollars. The Jacksonville chapter in one of thirty five in the country.
It must not be forgotten that, despite the disfigurement, Juliana is a bright, happy and healthy little girl.
