In a decade of repairing facial bones displaced and fractured by all manner of trauma, Lance Svoboda had never seen anything quite like this.
Broken lower jaw. Broken upper jaw. Broken cheek bone. Broken eye socket.
All in a 5-year-old girl who had been airlifted from her hometown of Alexandria, Minn., where her head had been crushed in a stairway elevator system.
“You don’t see a lot of fractures in young children because their bones are like sapling trees,” Svoboda said. “They bend and kind of crack, but they don’t usually separate.”
Today the caregivers and the parents of Reagan Lennes, now 6, can look back with awe at the girl’s recovery, though she was at Hennepin County Medical Center in Minneapolis on Tuesday morning for a corrective procedure to one ear.
But flash back to March 12, 2014, and Svoboda, a maxillofacial surgeon at HCMC, was challenged with not only the surgical reconstruction of Reagan’s face, but also how to do it in a way that would allow for her continued growth.
“Even in an adult, these would be terrible fractures,” he said.
The day of the accident had been ordinary. Reagan’s mother, Lisa, had painted 10 letters spelling “Love Reagan” across her daughter’s fingernails and sent her with her younger sister to a friend’s house to play.
Then came the phone call from a babysitter at the friend’s house, apologizing profusely. Reagan’s head was bleeding heavily, the babysitter said, and an ambulance was taking Reagan to Douglas County Hospital in Alexandria.
Reagan was barely identifiable in her hospital bed, but her mother could see “Love Reagan” still painted on her fingernails.
The force of the moving elevator had trapped Reagan’s head, cutting it from one ear, around the back of her head, to the other ear. Reagan was flown to HCMC’s pediatric trauma center, where step one became stitching and stapling the foot-long wound to close it and staunch the flow of blood.
Svoboda knew he couldn’t reattach the fractured facial bones using the latest flexible plates. While they offer the advantage of dissolving over time, so they don’t need to be surgically removed, Svoboda said the plasticlike plates would not have been strong enough to hold the flotilla of healing bones together — especially as Reagan grew.
Instead, three days after the accident, Svoboda aligned the bones together, using titanium screws and plates inserted through incisions in Reagan’s mouth, to avoid creating facial scars.
Imaging scans showed no evidence of brain damage, and Reagan responded to questions right before Svoboda’s surgery with a thumbs up or down. A tracheotomy tube to ensure sufficient oxygen to the lungs limited her ability to speak.
“ ‘Raise your thumb up if you want us to get you a real rabbit,’ ” Lisa recalled asking her. “Boom, the thumb flew up.”
Friends created a Rabbits for Reagan campaign, and hundreds of pictures of rabbits arrived from across the country along with donations to support the family as her parents took time off work to be with their daughter.
One month later, Reagan returned home, and the family dealt with the psychological trauma for Reagan, who remembered the injury, and her sister, who was riding on the elevator with her and saw it happen. Making good on the hospital-bed promise, her parents brought home a brown bunny, which Reagan named Gloria.
Doctors frequently monitored the healing and growth in Reagan’s head to determine the exact moment to remove the titanium plates. Leaving them too long would allow the bones to fuse to them.
“It’s a dance,” Svoboda said. “You’ve got to allow the bones to heal, but they’re healing so quickly. You don’t want these plates to get buried in the bone.”
After seven plates and 21 screws were removed at HCMC in June 2014, Reagan continued her return to a normal childhood of gymnastics and horse riding. She appeared in a bunny-themed float at a summer parade, and then was a flower girl in the wedding of a first responder who had helped her on the day of her accident.
Now Reagan is looking forward to first grade with a teacher who, rumor has it, gives out gum at the end of class.
“She’s very motherly, very caring of other kids, very teachery,” her mother said. “She wants to be a dentist when she grows up.”
Svoboda said the only follow-up procedures will be as needed if problems arise as Reagan grows. The injury had caused one of her ear canals to squeeze shut, so on Tuesday she underwent a procedure to open it again.
Children undergoing facial surgeries sometimes end up with misaligned jawbones by their late teens, so doctors will be monitoring her for that.
“Time,” her mother said, “will tell.”