CAN YOU FIX A BROKEN SMILE?

Plastic surgeons at Macquarie University Hospital have used highly specialised microsurgical techniques to reanimate the paralysed face of a patient.

Just over a decade ago, Jo Vardanega had required life-saving surgery to remove skin cancer that had spread into his parotid gland. The surgery involved removing a large amount of tissue – from the left side of his face and neck – as well as the facial nerve. This was followed by radiation treatment, which cured Jo and allowed him to get on with his life.

The removal of Jo’s facial nerve – responsible for creating the fine movements of the facial muscles, which protect the eye and convey emotions – meant he was left with one side of his face paralysed and hollow. Most importantly, Jo had lost the ability to smile.

“I’d look in the mirror and it just wasn’t me,” said Jo. “In photographs, which leave a lasting memory, my face would be all distorted. When my daughter got married a few years ago, I couldn’t face the photos. To see no smile – just a sagging face – was really hard. Over the years, I became withdrawn and it had a big social impact on me. I’d given up, in a way.”

Knowing there would be more weddings and photographs to come, Jo was determined to see if anything could be done to restore movement to his face and improve the asymmetry. Jo was referred to Associate Professor Gazi Hussain, a specialist plastic surgeon with an expertise in facial reconstructive surgery at Macquarie University Hospital.

Because the facial nerve and facial muscles on the left side of Jo’s face were no longer functioning, Associate Professor Hussain decided to transplant a muscle from Jo’s upper thigh into the left side of his face. The blood vessels were joined using microsurgery and the nerve of the muscle was connected to the nerve controlling one of the biting muscles in Jo’s jaw.

There was no guarantee that the operation would be successful as the nerves had to grow through the area of scarring into the transplanted muscle. After nine months, one day while driving, Jo suddenly began to feel the side of his face move. When he clenched his teeth, he could see the beginnings of a smile when he looked in the mirror. With physiotherapy and training, his smile has grown bigger.

Jo has gone on to have further surgeries consisting of grafting fat from his abdomen into his face to increase the volume and improve the symmetry lost due to the cancer surgery and radiation treatment. He had his final surgery in November – also at Macquarie University Hospital.

Jo is feeling much better about his face and is now looking forward to attending his son’s wedding later in the year and smiling for the photographs.

“I think it’s important for patients with facial paralysis – from cancer surgery or other diseases – to look into the options for restoring facial movement,” said Associate Professor Hussain. “Many will have been told by surgeons that there is nothing more that can be done for them. However, this might not be the case.

“We underplay the importance of smiling. But something as seemingly simple as this plays a huge role in our connection with others, emotional wellbeing and quality of life.”