New Surgery Brings Back a Smile

Paralyzed patients regain facial function through muscle transplant

MONDAY, July 16, 2007 (HealthDay News) -- By detaching, rerouting and reattaching a muscle used for chewing, surgeons were able to restore the ability to smile to seven patients with facial paralysis.

The procedure, called temporalis tendon transfer, is combined with intense physical therapy before and after surgery and could help similarly stricken patients right away.

"It's really a very doable procedure, and we're realizing how it can be done more simply," said study lead author Dr. Patrick Byrne, director of facial plastic and reconstructive surgery in the department of otolaryngology and head and neck surgery at The Johns Hopkins University School of Medicine in Baltimore. "It's very applicable on a wide scale," he added.

According to the study, which appears in the July/August issue of Archives of Facial Plastic Surgery, correcting facial paralysis is one of the biggest challenges facing reconstructive surgeons.

"Facial paralysis in general is really a complicated condition depending on the degree of facial paralysis, the areas involved and especially also on how long they've been paralyzed," Byrne said. "There are a lot of options, but, for patients with longstanding paralysis where we can't get the nerves to reawaken, then the options prior to this have been other forms of muscle transfers."

But those procedures were often problematic.

Temporalis tendon transfer addresses one aspect of facial paralysis -- the inability to smile, as well as an asymmetry in the lower half of the face.

Previously, surgeons used a different portion of the same muscle to try to restore function, a procedure that left the patient with some function but also facial deformity.

"The way it was done produced a depression or cavity in the temple region and a large protrusion around the upper cheek," Byrne said. Furthermore, "The [transplanted] muscle itself has trouble moving well because of its unnatural position," he added.

For the new procedure, surgeons took the temporalis muscle, normally used for chewing, detached it, rerouted it and reattached it to the muscles around the mouth. With physical therapy, patients learned to smile again by contracting the muscle.

"It would be called a 'dynamic' procedure, because it does provide function," Byrne explained.

The current study involved seven patients who, at four months after surgery, reported "very high" satisfaction. Out of a possible 10 points, participants gave appearance an average score of 8.4, feeding 8.1, speech 8.7 and smile function 7.1.

Physicians not involved with the study saw photographs of the patients and rated four of them "excellent to superb." The other three got "good" post-operative results.

One expert said any advance is important for these types of patients.

"It is a slightly easier alternative to the more traditional transfer of muscle that we use," said Dr. Yael Halaas, a board-certified facial plastic surgeon in New York City. "This is a tragic problem. People can have one side of their face essentially a deformed mask, so anything that might be possibly successful really gives an interest and this does look like a nice, possible procedure," she said.

Some of benefits are tough to quantify, Byrne added.

"Facial paralysis is absolutely devastating. When you talk to patients, what bothers them the most of all the myriad problems, the inability to smile is the number one thing mentioned by these patients," he stated.

And recent research lends credence to what your mother always told you: Smile and you'll feel better. The emotions shown on the face affect a person's internal state.

"People who smile are happier, and people who can't smile are depressed. It really affects the brain," Byrne said. "There's no question we've seen this in these patients. They are happier and more upbeat after having this procedure."

More information

There's more on this topic at The American Academy of Facial Plastic and Reconstructive Surgery.

SOURCES: Patrick J. Byrne, M.D., director, facial plastic and reconstructive surgery, department of otolaryngology and head and neck surgery, The Johns Hopkins University School of Medicine, Baltimore; Yael Halaas, M.D., board-certified facial plastic surgeon, New York City; July/August 2007, Archives of Facial Plastic Surgery
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