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, one side of Sims’ face was left paralyzed – drooping and lifeless on the affected side.
Anticipating the loss of facial symmetry and muscle function, Barbarite performed some reanimation procedures during the parotidectomy. A static suspension used sutures to elevate tissues of the mid-cheek and corner of the mouth. Two nerve transfers were also performed:
- A branch of the masseteric nerve, which allows clenching of the jaw, was transferred to the facial nerve branch that elevates the corner of the mouth. This would allow Sims to smile when biting down.
- A second transfer took a small portion of a branch of the hypoglossal nerve, which controls muscles of the tongue, and attached it to a branch of the facial nerve to improve muscle tone of the face. This type of transfer may take months to take effect.
Six weeks following the initial surgery, Sims went back to the operating room where Barbarite performed several additional reanimation procedures to reduce the droop of his upper and lower eyelids. These procedures included a brow lift, eyelid weight, lower eyelid tightening.
Facial reanimation is a developing practice
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 benefits of reanimation procedures can offer improved facial symmetry and function and restoration of facial movement and expression. The procedures used 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.
- Static suspension: Internal sutures are used to elevate drooping tissues to counteract gravity and improve overall symmetry and the appearance of muscle tone.
A smile returns
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.”