New Surgery Brings Back a Smile

Mar. 23 -- MONDAY, July 16 (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.