European Stars and Stripes (Newspaper) - September 14, 1977, Darmstadt, Hesse                                Wednesday september 14, 1977 the stars and stripes Page 19 modern living e by wet Kathy before after operation to Correct effects of Crouton s disease. Cuts top sketch were made in Kathy s Skull Bone grafts placed after Skull was extended. By Donald g. Mcneil or. New York times t the age of 17, Kathy was an Honor student in her Georgia High school and a talented musician but her grotesque appearance so frightened people that she shied away from All but a few close friends. Her jaws did t meet so she never took her food in front of anyone be cause she was too embarrassed to fish out the food that stuck in her  was born with Crouton s disease. Parts of her Skull had hardened Early in in fancy caving in the Center of her face and bulging out her eyes where the brain behind them was trying to find room to grow. Nigel was born in Guayana with Treacher Collins syndrome a birth defect of the lower face. He had Cleft cheekbones so the skin around his eyes sagged giving him a bloodhound s sad look. His underdeveloped lower jaw left his Chin Down near his Adam s Apple and his ear Bones rotated Down and fused making him nearly deaf and very hard to understand when he spoke. Not so Long ago Nigel and Kathy might have been abandoned at birth or turned Over to travelling circus Freak shows. Even now some children of Normal intelligence with genetic defects like theirs Are in institutions where they become retarded by Iso lation from speech and a family s love. Those who Are brought up at Home Are Usu ally shy and withdrawn scarred by school mates who Call them monsters and teachers who ignore them As morons. Until recently there was no treatment. But in the last few years new Surgi Cal techniques aa4 the development of team diagnosis and treatment of patients with birth defects have prompted the setting up of centers for craniofacial anomalies at hospitals in new York Chicago Boston Char Lotte va., and other cities. Many of the Hospital facilities Are out growths of existing Cleft palate clinics and they look for inspiration to the Foch Hospi Tal in Paris and the new York University medical Center where new techniques Are incubated. Patients such As Nigel and Kathy Are seen by As Many As 20 specialists who then meet and coordinate a treatment plan that might include Skull surgery dentistry cos Metic surgery orthodontics braces speech therapy and treatment for ear infections congenital heart defects clumped fingers or other problems that often accompany craniofacial syndromes. We d be extremely remiss if repaid attention Only to the cosmetic de lets of our patients or to their speech said or. Robert Shprintzen director of the Montefiore craniofacial Center in new York. He also directs patients to see a Psychia Trist a genetics Counselor and a social worker. Children with birth defects have historically been haunted by a myths that their afflictions Are caused by bad blood parental sins or even the Odd Frog or Rabbit who startles a pregnant Mother. Some parents blame each other and marriages break up Shprintzen said so the child May carry a tremendous Load of guilt. A genetic work up including photo graphs Han prints and a family history can help diagnose the syndrome what caused it and whether other members of the family have it to lesser degrees. The costs of the new team techniques can be overwhelming. A social worker can often help find the Means for a patient to pay for an operation. Although the surgeons often charge no fees hospitalization costs can run to $400 a Day. We lose Money for the Hospital Shprintzen said. Plastic surgeons make their Money on noses breast Sand behinds. But malformed children Are the Pride and Joy of their  a conference of All doctors who play a role in the diagnosis is held on each patient. Slides a rays of the Skull and a Ray videotapes of palate control Are shown and the doctors compare notes and arrive at a plan of treatment. At some clinics like that at the Kings Brook jewish medical Center in Brooklyn plaster models of the patient s jaw and Skull Are placed on a table and the intended incisions and surgery debated. It can get pretty heated one Confer ence participant said. You can almost never get a plastic surgeon and an Oral surgeon to agree. And the paediatrician is very valuable he s reluctant to see any body operate on anybody because he s concerned with the patient s health. But we insist on unanimous consent to a plan or we go to a More conservative  the most Radical part of the treatment and the Only one that cures the Gross Defor mity is plastic surgery on the facial Bones and upper jaw. Such operations can involve cutting and rolling Down the skin of the face to nose level removing the forehead Section of the Skull shrinking and retracting the brain cutting the Eye socket Bones or the whole face free repositioning the Eye socket Bones and wiring them in place with the gaps filled by Bone grafts. This is the technique used for Crouton s disease hyper Telor ism eyes on the Side of the head and other deformities of the upper face. Pioneered by or. Paul Tessier at the Foch Hospital in Paris after years of experiments on cadavers at his old medical school the technique changed the whole leadership of facial work from Oral surgeons and dentists to a team of neurosurgeons and hard tissue plastic surgeons who expose the front and Back of the face moving the eyes and brain from harm s Way before starting to Cut Bone. The operation on Kathy was performed at the . Medical Center in 1973 by or. John m. Converse. In the Case of Nigel who is 22 years old or. Ravelo v. Argar Naso of Montefiore Hospital peeled the skin Down from the Scalp so the hair would conceal the scar made new cheekbones out of one of Nigel s ribs and wired the new cheekbones to the rudimentary Bones there. Then he went in behind the lip again hiding the scar exposed the jaw sawed off its lower Edge and Laid it Over what was left. He took part of another rib and Bent it Over the repositioned jaw creating a new Clinin and a Normal profile. Nigel will get a hearing Aid and More plastic surgery to improve his appearance further. For now he is studying masonry in which he apprentice in Guyana and wants to stay in the United states Al though he won t Boa t about it the doctors think at least one Yum woman has become attracted to him lie smiles a lot More than he Ever did lx-1 Ore surgery the physicians noted