The nerve ‘transfer’ making facial trauma patients smile again

A man whose facial muscles were paralysed can now eat, speak and blink again thanks to surgery that transferred nerves and fat from his groin into his face.

It is hoped the pioneering procedure, a world first, will now be used on other sufferers of facial palsy – a weakness of the facial muscles caused by damage to the nerves that affects 25,000 Britons every year.

The most commonly known trigger is Bell’s palsy, a temporary weakness or lack of movement affecting one side of the face which most recover from within a year.

It is hoped the pioneering procedure, a world first, will now be used on other sufferers of facial palsy – a weakness of the facial muscles caused by damage to the nerves that affects 25,000 Britons every year

But many other causes can leave the face permanently damaged, such as a facial tumour or a traumatic injury to the area.

While nerve graft surgery – where a nerve is taken from elsewhere in the body and implanted into the face – can restore movement, there are particular challenges with some patients.

Cancer surgery and radiation can cause significant scarring and damage to facial tissue which affects the tissue and blood supply in the area. This means nerves are less likely to repair and regrow.

What’s more, if nerve grafting surgery is not performed within 18 months of the initial nerve damage, the facial muscles can die.

Now a new operation is offering fresh hope even for patients with severe facial trauma. The treatment inserts not only a new nerve, but also blood supply, skin and fat to fill in facial deformities that result from previous surgery.

Now a new operation is offering fresh hope even for patients with severe facial trauma

Now a new operation is offering fresh hope even for patients with severe facial trauma

James Parkin, 43, from Hampshire, had the 12-hour procedure in August 2016 after surgery to remove a tumour in his facial nerve destroyed sensory function in the right side of his face, leaving it paralysed.

Removal of this growth and then radiotherapy led to sunken tissue in his right cheek which left James, a singer-songwriter, unable to speak, smile, eat or close his eye.

The father-of-one was referred to Queen Victoria Hospital in East Grinstead, a centre of excellence for facial reconstruction.

During the operation, a 6in-long nerve was taken from his thigh, and blood supply, fat, skin and tissue were removed from his groin. The nerve was stitched in place via a tunnel under the skin between the jaw and the facial muscles.

Now I can puff up my cheeks, pout my lips and blink – I haven’t been able to do that since before I had the cancer. I would give anything to smile again but I am just happy to be alive

One end of the nerve, which is less than 1mm in diameter, was connected to the ‘chewing’ nerve, while the other was split into four separate branches with each joined to the existing facial nerve ends responsible for movement in the eyelids, cheek, chin and lips. The skin and fat was then used to fill the facial hollowing and the blood supply was stitched to arteries and veins in the neck.

The transplanted nerve encouraged new parts of the nerve to grow, strengthening the connection between the brain and the muscle.

A tiny platinum chain was also implanted to help James close his eye; this weighs down the eyelid and helps it close by itself.

‘It was a novel operation that has not been done anywhere else in the world,’ says surgeon Ruben Kannan, who specialises in facial palsy and reconstructive microsurgery.

Within nine months of the operation, movement was restored in James’s eyelids and surgeons expect his smile to return in the next six months.

James has since written an album of songs to document his journey.

The musician said: ‘When I came out of cancer treatment, I was told there was nothing they could do to restore facial function, so when Mr Kannan said that he could restore feeling by between 50 and 100 per cent, it was a “wow” moment.

‘Now I can puff up my cheeks, pout my lips and blink – I haven’t been able to do that since before I had the cancer. I would give anything to smile again but I am just happy to be alive.’

James is supporting Cancer Research UK’s Right Now campaign to beat cancer sooner. 

  • For more information, visit cruk.org and facialpalsy.org.uk.

 



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