We’re headed off to the hospital tomorrow, for more procedures. Namine is having two things done: dental work and a bronchoscopy.

Something I never really thought about in relation to Namine having Pierre Robin sequence is her teeth. But it makes sense, once you think about it: her jaw is regressed (less so than before the jaw distraction, true, but it is still further back than a normal child’s); this will of course affect the growth of her teeth as well. And it has – Namine’s teeth have grown closer together, having had less space to grow in. This has resulted in a few impact cavities: cavities which have formed because the growing teeth are grinding against each other, which wears them down.

So in tomorrow’s procedure, they’re going to fill the cavities. Namine is only four, so they are going to knock her out for this. They may decide to extract a tooth in order to make room; that decision will wait until they’re actually in the OR and can see how tightly compacted the teeth are. (Of course they will consult us before actually going ahead and removing the tooth.)

The bronchoscopy, on the other hand, is nothing new, but by no means does that make it trivial. Namine needs a bronch pretty regularly, to ensure that her airway is still doing fine. After all, no one knows how her jaw and airway will continue to develop. (Dr. Denny, the plastic surgeon who did her palate repair and jaw distraction, predicted that her jaw might cease to grow, making further distractions necessary; but he has thus far been proven wrong. Just another case of Namine throwing out the rule book, I think.) A bronch being what it is, Namine must be unconscious for the procedure. Usually they put the tube down her throat through her mouth; this time, due to the dental work being done, they’ll be going in the nose and down.

When she wakes up, I expect her to be in pain. I always hate to see her in such discomfort, and you can’t always explain why it was necessary. I pray that all goes quickly and without incident.