CLEVELAND, Ohio (Ivanhoe Newswire) – How many times a day do you smile? Research shows that children smile an average of 400 times a day. But what if your child physically could not smile? Babies born with facial paralysis cannot control their muscles in the face. Until now, there was little doctors could do for them. A pioneering procedure is now allowing children to show off their beautiful smiles.
Born with unilateral congenital facial paralysis, Nicole Serena-Gonzalez grew up not able to move the right side of her face. Her parents feared what the future may hold for their fun-loving little girl.
“Most kids don’t come with the intentions of being mean; it’s the way they phrase it that might hurt her feelings sometimes,” Nicole’s mother, Carolina Gonzalez tells Ivanhoe.
Until now, surgeons have used techniques to improve the function of the facial muscles, but are looking into a way to “a full range of human emotion.” A team at the Cleveland Clinic pioneered a new type of procedure called a Tri-Vector Gracilis Free Tissue Transfer.
Facial Plastic and Reconstructive Surgeon at the Cleveland Clinic, Patrick Byrne, MD, explains, “The goal was that we would restore a full smile as well as a linked movement around the eyes.”
Dr. Byrne took the sural nerve from Nicole’s lower leg and connected it from Nicole’s functional left side to the paralyzed right side.
“It’s kind of like taking an appliance and plugging into a functional outlet on the other side of the room because that’s where the power’s coming from,” Dr. Byrne illustrates.
He also took a band of muscles from Nicole’s left thigh and inserted part near her lip, part near the corner of her mouth, and another part near her eye. And now, a year after surgery, she’s got a lot to smile about.
“I love my smile. It improved a lot,” Nicole expresses.
Over the next few years, Nicole’s facial control will continue to improve and her movements will become more natural.
Contributors to this news report include: Marsha Lewis, Producer; Kirk Manson, Videographer; Roque Correa, Editor.
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Source:
MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: A PIONEERING SURGERY GIVES NICOLE HER SMILE
REPORT: MB #5277
BACKGROUND: The gracilis muscle is found in the thigh and can be used in the correction of facial paralysis. In this procedure, the gracilis muscle is taken from the inner thigh and the nerve/blood vessels attached to the muscle are carefully removed along with it. Those nerves and blood vessels will then be reattached to the nerves and vessels of the face and neck. The nerve is typically attached to the masseteric nerve which lends way to gracilis contraction (a smile) when the individual bites down. This new movement is called “bite to smile” and the patient would need rehabilitation to practice this gesture.
ELIGIBILITY: The gracilis free tissue transfer can be performed at any time facial paralysis occurs. It’s common that patients who opt to have the procedure were experiencing facial paralysis for two or more years. This treatment is available for those fully void of facial movement and for those with partial movement. The masseteric nerve (found in the inner thigh) is a crucial component of this surgery; therefore, a patient must have a properly functioning masseteric nerve to qualify for this procedure. Patients typically remain in the hospital for 4-5 days post-surgery. Swelling will occur but usually softens a few months after the procedure. Initial signs of improvement present themselves about 6 months later and the progress strengthens over the first year after surgery.
NEW TECHNOLOGY: To repair Nicole’s smile, there were a series of steps her doctors followed to restore range of movement. The first step was harvesting a nerve from her leg called the sural nerve, which is a sensory nerve. The nerve is taken from a muscle in the leg that isn’t really important for everyday use or even in sports. It’s trimmed, thinned, contoured, and converted into multiple different slips by preserving the small arteries and branches of nerves between each one. That nerve is then redirected and repurposed with the mass nerve – a nerve in the face that’s used for chewing. Her doctors suspected that a dual innervation approach increased the likelihood of success and allowed for a more natural looking smile.
(Source: https://www.ivanhoe.com/)
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Halle Bishop Weston
If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com
