Treating Madeleine One Step at a Time:
Stephen Schendel, M.D., D.D.S.

Sixteen-year-old Madeleine Linares reminisces with cranio-facial surgeon Stephen Schendel, M.D., D.D.S., about her lifetime of surgeries to fix a congenital malformation of her face and jaw.

SPRING 2004 - First grade. Second grade. Fourth grade. Eighth grade. Each fall in school pictures, Madeleine Linares' face looks a little fuller, her nose a little straighter, her smile more radiant. "You can really see the change. It's pretty cool," says Linares, a longtime reconstructive surgery patient at Packard Children’s Hospital who is now well into her junior year at Santa Cruz High.

Linares started seeing Stephen Schendel, M.D., D.D.S., director of Packard's Craniofacial Anomalies Center, when she was 5 for treatment of hemifacial microsomia, a congenital malformation that affects about one in 3,000 children. Patients with the condition typically have jawbones that are much smaller on one side; they also may be missing an ear or cheek muscles, giving the face a lopsided appearance. In severe cases, they can have trouble opening their mouths or even breathing. The Craniofacial Center at Packard, a multidisciplinary team, sees approximately 500 children a year with various diagnoses like Linares'.

Schendel, who travels the world helping kids with cleft palates and other facial problems, started Linares' treatment with a bone graft, taking a piece of one of her ribs to lengthen her lower jaw. A few years later, he performed a mandibular distraction, a technique that involved dividing Linares' lower jawbone and attaching an external brace that stuck out from her face to hold the bony ends about a millimeter apart. By turning screws that went through her cheeks over a two-week period, her parents were able to increase the gap ever so slightly each day, stimulating her jaw to grow thicker and longer.

Linares has been undergoing surgery for her condition since she was 5 years old.

When Linares was 14 years old, Schendel set out to lengthen the girl's jaw one more time – this time using an improved stretching device on one side of her face that could be placed completely under the skin. The state-of-the-art titanium brace, which Schendel personally designed with the help of a Dallas engineering firm, fits easily into the palm of the surgeon's hand. All the adjustments can be done inside the mouth, eliminating the need for screws through the face.

Today, Linares is a confident young woman who is looking forward to college and perhaps a career in architecture, history, or design. Although the surgeries were a lot to go through, she gives Schendel points for being candid. "Especially when you're little, a lot of doctors don't really tell you what's going on, or they use big words that no one really understands," the 16-year-old soccer enthusiast says. "But Dr. Schendel explained what he would be doing and how I would feel afterwards. He always gave me an idea of what to expect. And that was really nice."