The surgery was scheduled for Oct. 30, 2005.

“Preparing for the night before the surgery was pretty difficult, because we knew that she couldn’t have anything to eat for 12 hours prior to the surgery, and like any baby, at that time she was used to having a bottle every few hours,” Daniel says. “We were pretty stressed out about it, but she ended up falling asleep and sleeping almost the whole night before we had to leave our house for St. John’s at 5 a.m.”

Later that morning, as they handed their baby girl over to a nurse to be carried in for surgery, Kim says she and Daniel immediately felt calm.

“We knew she was in good hands and that God was going to take care of her,” Kim says. “I can’t explain it. Normally, I’m a wreck in those situations, but I was completely calm.”

Surgery to repair craniosynostosis takes about four hours. The surgeons make a zigzag incision from ear to ear across the top of the head to prevent damage to the hair follicles.

“I use the same cosmetic techniques in this surgery as I do in other reconstructive cases. I work around the follicles so the baby’s hair will cover the scar,” Dr. Shah says.

The team approach in this surgery has proven very effective, Dr. Khoshyomn says.

“Some hospitals have either a neurosurgeon or a plastic surgeon performing this surgery. We’ve found the best outcomes have come from both surgeons working together, because there are two components to this procedure – removing the diseased skull, then remodeling it so it’s aesthetically pleasing and symmetrical,” he says.

Once the scalp is peeled back, pilot holes are drilled through the skull. These pilot holes are then connected, separating the skull into several pieces. Once reshaped, these pieces are placed back on the head correctly and held together by a combination of dissolving sutures, plates, and screws.

Demineralized bone matrix or bone morphogenetic proteins are often used to fill gaps left by the expanded skull, encouraging the body to grow new bone.

“We were prepared for the worst once she came out of surgery,” Daniel says. “We’d seen photos of babies after this surgery who came out looking very bruised and swollen. But McKinley looked good.”

“Everything went smoothly and was as wonderful as an experience like this could be,” Kim adds.

McKinley stayed in the Pediatric Intensive Care Unit for three days post-surgery, then was moved into a regular room on the Pediatrics floor.

Her parents stayed in a room at St. Johns’ Hospitality House while she was in the PICU and in her room with her once she was moved to the Pediatrics unit.

About a month after surgery, McKinley was fitted with her molding helmet, which she wore 24/7 for about three months. She had follow-up visits with Dr. Khoshyomn at six months and one year after her surgery and is now a “fearless” 3-year-old who loves being outside, swimming and attending preschool, her mom says.

Dr. Khoshyomn encourages the Scotts to drop in his office now and then so he can keep up on McKinley.

“She has a very special place in my heart because she was my first patient at St. John’s,” he says.

The feeling is mutual, Daniel says. "We are big fans of Dr. Sami’s,” McKinley’s dad says.

Dr. Khoshyomn says it’s his and Dr. Shah’s mission to provide this surgery to any Ozarks child who needs it, regardless of their ability to pay.

“Children born with the most simple form of this abnormality may not suffer ill effects from it, other than having a deformed head. For others, craniosynostosis can result in developmental delays. Whatever the case, we’ve found that children who have craniosynostosis and don’t have the surgery to correct it are historically not as high-functioning in society as their counterparts,” he says. “Providing this surgery to kids who need it is probably the most rewarding thing we do.”

The normal skull consists of several plates of bone that are separated by sutures. The sutures (fibrous joints) are found between the bony plates in the head. As the infant grows and develops, the sutures close, forming a solid piece of bone, called the skull.

Craniosynostosis is a condition where the sutures close too early, causing problems with normal brain and skull growth. Premature closure of the sutures may also cause the pressure inside of the head to increase and the skull or facial bones to change from a normal, symmetrical appearance.

Craniosynostosis occurs in one out of 2,200 live births and affects males twice as often as females. The condition most occurs by chance. However, in some families, it is inherited

In infants with this condition, the parents or the child’s physician may immediately notice changes in the shape of the head and face. The appearance of the child’s face may not be the same when compared to the other side. Other clinical findings may include:

■ Unilateral coronal synostosis is the most common form, which produces a flattening of the forehead and brow, with the forehead tending to be excessively prominent on the opposite side. The eye may also have a different shape and there may be a flattening of the back of the head.

■ Coronal synostosis produces a flattening of the forehead and the brow on the affected side, with the forehead excessively prominent on the opposite side. The eye on the affected side may also have adifferent shape. There may also be a flattening of the back of the head.

■ Deformational (or positional) plagiocephaly refers to the misshapen head from repeated pressure to the same area. This is not a true synostosis. It can result when part of the head flattens out due to pressure, as when sleeping repeatedly on that part of the head.

■ Trigonocephaly is a fusion of the forehead suture, which runs from the top of the head down the middle of the forehead, toward the nose. Early closure of this suture may result in a prominent ridge running down the forehead. Sometimes the forehead looks pointed, with closely placed eyes.