Girl with Muscular Dystrophy Undergoes Surgery to Restore Smile

A seven year old girl, Carla Hughes, in Ireland with facial paralysis due to Muscular Dystrophy (MD) has recently undergone a surgery to restore her smile. The surgery that was performed was groundbreaking because of the way it was done and because of the disorder. MD is a degenerative disease that causes muscles in the body to weaken and lose functionality, over time it becomes difficult if not impossible for some tasks to be performed. In the case of muscles in the face, when the muscles weaken it causes the patient to lose expressiveness and the ability to smile.

The maxillofacial surgeons in the this particular case used a free muscle transfer technique to transplant working muscles and nerves from the child’s legs into her face to restore functionality. Although currently in recovery and physical therapy to relearn how to use the facial muscles, the child's prognosis is good. Although there is no data to suggest whether or not these newly transplanted muscles will also fail with the progression of the disease.

While this type of reanimations surgery is not often performed on patients with MD, it’s still a form of maxillofacial surgery, and is more often associated with disorders that affect the mouth, jaws and facial regions. Those disorders can range from simple things such as impacted wisdom teeth to a misaligned jaw.

What are Reanimation Surgeries?

The muscles of the face can fail for any number of reasons not related to degenerative disorders. One of the most common reasons is the after effects of a stroke. When people suffer a stroke, most often the suffer paralysis on one side of the body. This can happen in quadrants where only the trunk and legs are affected, or the upper torso including the head and face. If the head is involved, the muscles of the face generally are as well, and the patient is left with a face that droops on one side.

The effects of a drooping face are not simply vanity, it can cause many complications of everyday life for the affected party. Drooling can be an issue for some if the mouth will not close all the way. If the muscles of the throat on the affected side are involved, there is not only the issue of trouble swallowing, but chances of choking and aspiration of particles into the lungs, causing lung infections become a life threatening problem. Sometimes with physical therapy patients can regain some use of the paralyzed half of their body, unfortunately even with this gain, the effects on the muscles of the face usually remain negligible. There are several types of reanimation surgery that range from the simple to the very complex and serve different purposes.

Nerve Graft

This is a procedure that’s performed in the event that the muscles still retain their viability, but the nerves in the affected region of the face has died. The surgery will typically need to be performed within eighteen months of the accident as that’s how long the muscles will remain healthy and viable. Paralyzed facial muscles are connected to healthy nerves to restore the movement. The healthy nerve tissue is transplanted from another area of the face or body such as the neck or legs. Other techniques include using healthy tissue from other parts of the body to connect the paralyzed side of the face to the functioning nerves in the unaffected side. A nerve graft usually takes a year to heal and will normally restore most of the muscle functionality and nerve impulses to the affected side of the face.

Muscle Transposition and Muscle Transfer

Muscle transposition is a method of reanimation where healthy muscle is removed from another part of the face to the paralyzed section. The surgeon can then choose to reroute muscles from the unaffected side of the face. Muscles that are associated with chewing in another option to use in the particular procedure, this will allow the person to at least smile while clenching the jaw. This method is the preferred method when the muscles of the paralyzed side of the face have either atrophied or become destroyed. In addition to taking healthy muscle tissue from another area of the body like the leg, surgeons will also take blood vessels and nerves to completely rebuild that side of the facial muscle structure, by connecting the transplanted nerves and blood vessels to healthy native ones in the face so they work, through either a graft to the healthy side of the face or to a nerve that controls chewing . In order to allow such active facial motion as smiling, the surgeon must be carefully to place newly transplanted muscle in the right orientation

Some of the Procedures Performed by Oral Surgeons

Maxillofacial or oral surgeons are unique dental specialist because in addition to dental school, they also receive four years of surgical training making them some of the most highly trained surgeons and dentists. The specialty is focused on treating problems that occur in both the hard and soft tissue of the face within the range of oral surgeries.
Tooth extractions are perhaps the least complex and most oft performed surgeries that oral surgeons take on. While it may seem that a tooth extraction would be a simple procedure, it can at times become complicated depending on the location of the tooth, how many roots are present, their depth and the position that the tooth lies in. Wisdom teeth, particularly an impacted wisdom tooth that may have grown in on it’s side and impact the bite and surrounding teeth, are some of the hardest to extract. A wisdom tooth has four canals with roots in them. If the tooth is in a position where it can’t be easily lifted with an elevator, the surgeon may be forced to break the tooth and extract each root separately. A procedure that should have taken an hour, just turned into two.

Corrective jaw surgery is used when orthodontics have proven to be insufficient in realigning an overbite or underbite in a patient. It can also be used to repair congenital birth defects such as open bites, protruding jaw or a receding chin, along with skeletal abnormalities that result in severe jaw misalignments. These procedures are usually done under general anesthetic and involves reshaping the bones of the face while and repositioning the teeth and jaws. Cleft palate surgery falls under the purview of oral surgeons as well and involves connecting the tissue of the soft palate to close the cleft, leaving a tiny scar on the upper lip.

In addition to the specific surgeries fall under the maxillofacial umbrella, oral surgeons often work closely with plastic surgeons on cases where traumatic injuries require facial reconstruction, and are often asked to consult on many sleep apnea diagnosis. In addition they assess and tackle the removal of benign cysts and tumors of the facial region, perform cranial vault malformation surgeries, as well as asses and treatment of neck, oral and head cancers. 

Who May Need a Maxillofacial Surgeon

The procedure to restore the smile and functionality of a child with MD is nothing short of extraordinary. But the circumstances that lead one to an oral surgeon need not be quite so dire. Maxillofacial surgery is possibly the most simple, yet complicated discipline within the medical as it spans across so many fields, and tackles some of the most painful and easily solvable issues affecting patients. People that would benefit the most from visiting an oral surgeon are people that suffer from frequent migraines that can be caused by TMJ, almost any facial or head pain can usually be solved with a visit to an oral surgeon.