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Operation smile

Article-Operation smile

Johns Hopkins’ researchers recently published results from performing a modified muscle transplant operation to restore the ability to smile in patients whose faces had been paralyzed.

The paper, in JAMA Facial Plastic Surgery, shows the gracilis flap can be designed as a functional double paddle muscle flap for a multivector facial reanimation. 

Facial plastic and reconstructive surgeon Kofi Boahene, M.D., and colleagues performed facial reanimation for complete paralysis in 12 patients. Instead of the standard approach for people with one-sided facial paralysis of using transplanted muscle tissue from a patient’s thigh to pull up on the paralyzed side of the mouth, they did a modified procedure, using gracilis muscles placed in two or three directions. They placed the muscles at the corner of the mouth or the upper lip to the cheek and eyelid to recreate an authentic smile that shows teeth and gum on both sides of the face, according to a Johns Hopkins’ press release.

Dr. Boahene, professor of otolaryngology–head and neck surgery and dermatology at the Johns Hopkins University School of Medicine, says in a video about the procedure that his aim is to create normalcy in people’s faces who are paralyzed — meaning that if it takes a lot of muscles to create a smile, he tries to replace as many of those muscles as possible.

“Previously, the best we could hope for most of the time with surgery was a smirk, where just the corners of the mouth upturn in a smile like the one Mona Lisa has in DaVinci’s famous painting. But that isn’t a joyful, expressive smile where the lips move up, teeth show and eyes narrow. Now we’re able to really restore a true smile,” Dr. Boahene said in the press release.

The multivector design results in significant improvements in the dental display, smile width and correction of paralytic labial drape, the study authors write.

The study included 10 women and two men, ages 20 and 64 years. All experienced functional muscle recovery. Smiles that emerged post-treatment included, on average, exposure of 3.1 additional maxillary teeth and mean exposed maxillary gingival scaffold width improvement from 31.5 mm to 43.7 mm. Asymmetry was reduced from an average of 9.1 millimeters to 4.5 millimeters post-surgery.And four patients even noted dynamic wrinkling in the periorbital area.

The approach can help to restore authentic facial expressions of joy to select patients with one-sided facial muscle paralysis due to birth defects, stroke, tumors or Bell’s palsy. Most facial paralysis patients are candidates, regardless of how long they’ve been paralyzed. Other muscles can be used if patients have weak gracilis muscles, according to a Johns Hopkins’ press release.