Rare surgery gives girl her smile back
Posted on 24 January 2019
Chanel de Wet is 21 years old and unable to show emotion. Now, doctors hope a rare, complex and ultimately successful surgical procedure will bring her smile back.
A young patient has a chance to smile again after specialist surgeons at Mediclinic Louis Leipoldt completed a complex procedure to reanimate the right-hand side of her face.
De Wet developed a schwannoma in the tissue surrounding nerves on the right side of her face, known as the nerve sheath. An operation to remove the benign mass resulted in her facial nerve being affected, leaving her face partially paralysed, unable to show emotion, close her right eye, or eat and drink properly.
The nerve sheath protects the nerve and in many cases encroaches on the nerve tissue, which makes it exceedingly difficult to remove the schwannoma without affecting the nerve. De Wet lived with this condition for almost a year before doctors at Mediclinic Louis Leipoldt came together to help.
“The facial nerve connects your brain to the muscles in your face. It is what gives you your range of facial expressions,” says plastic and reconstructive surgeon Professor Frank Graewe. “Unfortunately, when doctors removed the tumour, they also severed her facial nerve.”
Professor Graewe played a central role in the surgery, together with ear, nose and throat specialist Professor Louis Hofmeyr and ENT surgeon Professor Justus Apffelstaedt. The operation took seven hours and was performed in theatre at Mediclinic Louis Leipoldt.
While the surgery was not risky in itself, it was complex enough to require specialist attention. De Wet flew from Johannesburg to seek treatment, which she could not find anywhere else.
Professor Graewe emphasises that key to the success of this procedure was teamwork. “Professor Hofmeyr opened up the temporal bone for us, so we could identify what was left of the nerve. Professor Apffelstaedt then did a partial superficial parotidectomy, removing the portion of the parotid gland surrounding the tumour. This helped us identify the peripheral part of the nerve. I then took a nerve graft from the leg, so I could perform an interposition nerve graft, connecting the main stump of the nerve to the remaining nerve endings.”
A nerve regenerates very slowly, he says, growing about one millimetre each day – and that is the optimal rate, providing the nerve stump locates the graft, if they are properly aligned, and if there are no issues with infection. In De Wet’s case, the nerve must grow all the way up into the muscles in charge of her facial expressions, a distance of about 20 or 25 centimetres. This means De Wet is about a year away from seeing results.
“Nerve regeneration is a tricky field,” says Professor Graewe. De Wet’s facial nerve may regenerate in unexpected ways, or develop complications that would require further surgery. “We will have to wait to see the extent of that regeneration and see how much she is able to recover before we make any decisions on that. She will need some physiotherapy and a full rehabilitation programme. It will be hard work for her. But she is a very optimistic person, and very motivated. This is very important. She now has a chance to regain some of her facial function.”