Larry Sims was known for his big smile. But a diagnosis of squamous cell carcinoma in his parotid gland – the largest of three salivary glands – would change that forever. Or, would it?
A team of surgeons in the Department of Otolaryngology, led by facial plastic surgeon Eric Barbarite, MD, thought otherwise. The multidisciplinary team also included neurotologist Nedim Durakovic, MD, and head and neck surgeons R. Alex Harbison, MD, and Patrik Pipkorn, MD. For 14 hours, the team worked to remove the cancerous gland and 55 regional lymph nodes thought to be involved.
During the cancer ablation, the facial nerve had to be sacrificed. That nerve controls the muscles of facial expression – muscles that raise the brow, squint the eyes, and adjust the lips to create smiles and frowns. As a result, Sims’ face was left paralyzed – drooping and lifeless on the affected side.
Six weeks following the initial surgery, Sims went back to the operating room where Barbarite performed several facial reanimation procedures to return some movement and symmetry to Sims face. The procedures included a brow lift, eyelid weight, lower eyelid tightening, and facial suspension and nerve transfers to dynamically reanimate his face. One of the nerve transfers entailed cutting the masseteric nerve that partially controls biting down and hooking that into the facial nerve branch that goes to the patient’s smile muscle. Once healed, that allowed Sims some degree of smiling when he bites down.
Facial reanimation is very much a developing art that allows the return of various types of facial expression following loss of facial nerve function due to Bell’s palsy, stroke, trauma or cancer.
The procedures used for reanimation are varied and often depend on the underlying cause and severity of facial nerve paralysis. Some common techniques include:
- Nerve grafting: Healthy nerves from another part of the body are transplanted to the paralyzed side of the face.
- Muscle transfer: Muscles from other parts of the body, such as the thigh or neck, are transferred to the face to provide movement.
- Temporalis tendon transfer: The tendon of the temporalis muscle (which controls chewing) is transferred to the paralyzed facial muscles.
The benefits of reanimation procedures can offer improved facial symmetry and function and restoration of facial movement and expression.
For Sims, the lack of symmetry in his face and the loss of his smile was disconcerting. But his facial movement has continued to improve, and he is happy with the result. He still receives speech and swallowing therapy, but he no longer drools, can eat most foods, and perhaps most important, friends say he has his smile back.
His wife Sherri concurs and commented on how great the surgeons were.
“The surgical team was terrific,” she said. “Dr. Barbarite was very friendly and supportive from the first meeting, and he checked in frequently after surgery. He is one of our favorite doctors.”