28 Apr 2011
By: NG WAN CHING
Eleven years ago, Madam Le Thi Bao, 53, stopped smiling – not because she did not want to, but because she could not.
Today, her smile is back, thanks to a type of surgery that is little known here.
This type of surgery, carried out by plastic and reconstruction surgeons, may utilise muscles and nerves from another part of the body to "re-animate" the face and offers patients the chance to smile again.
The operations have evolved and improved over time to deliver better results for patients.
The surgery that Madam Bao underwent involved one of such newer techniques.
The Vietnamese businesswoman had a brain tumour 11 years ago. She underwent surgery in Vietnam to remove the tumour, which left her with damaged nerves on the left side of her face.
Replying to e-mail questions from Mind Your Body, her daughter, Ms Tran Bao Yen, said: "Many years ago, my mum got a serious headache. When she went to the hospital, a seed was found inside her ear."
Surgeons in Vietnam carried out the surgery to remove the "seed" or tumour.
"Then her face changed. We realised that her nerves were affected and it made a difference to her face," said Ms Yen.
The ill effects were noticed some time after Madam Bao's surgery.
Deeply unhappy about the way her face looked, she gave up working and stayed home in Ho Chi Minh City.
Search for smile surgeon
She and her family searched all over Vietnam for help.
"We consulted many doctors and professors, but no one could help," said Ms Yen.
Then, Madam Bao read in a magazine about someone like herself, who was helped by Associate Professor Lim Thiam Chye, the head of plastic, reconstructive & aesthetic surgery at National University Hospital (NUH).
"We found out about Prof Lim and where he works," said Ms Yen.
In November 2008, mother and daughter made their way to Singapore and NUH, where they met Dr Ong Wei Chen, a consultant in the same division as Prof Lim.
She had returned a couple of years earlier from overseas, where she had learnt a few techniques on "re-animating" a person's face which had been frozen by illness or surgery.
This newer type of surgery, which NUH has been offering under its Facial Reconstruction And Re-animation Service since 2006, aims to improve one particular aspect of facial paralysis – the ability to smile.
It is also done to improve function, like stopping the patient from drooling on the affected side of the face.
Said Prof Lim: "Things like constant drooling can cause a patient much discomfort."
The surgery performed on Madam Bao was done by taking a band of fibrous tissue, called a fascia graft, from her thigh and connecting it to a muscle on the paralysed side of her skull.
The muscle on the skull, called the temporalis muscle, would still be functioning as it is powered by a different nerve from the one which powers the facial muscles.
Said Dr Ong: "When the patient clenches her teeth, she can feel the temporalis muscle contracting, even though that side of her face is paralysed."
The surgery is done through an incision that is very similar to what is commonly used in face-lifts.
Through the face-lift incision, which is by the side of the ear, the fascia graft is inserted and attached to the temporalis.
Then three or four small cuts are made around the top, bottom and corner of the mouth, and by the side of the nose.
The fascia graft is then divided into several smaller strips and surgically "hooked" to these strategic parts of the face underneath the skin through the small cuts.
The fascia graft, now connected to the temporalis on one end and to various parts of the face on the other end, can then be trained to move the corner of the mouth when the patient smiles.
Each strip of the fascia graft can help lift the paralysed side of the face (see graphic).
"Typically, it takes a motivated patient much physiotherapy to learn how to use the new graft and smile again," said Dr Ong.
However, some patients can start smiling and moving their paralysed side less than a week after this operation. "Also, the scars are generally very well concealed," said Dr Ong.
So far, NUH has done six such operations, including that for Madam Bao.
Low awareness of treatment option
"The reason for the low number could be that there is very low awareness that such a service is available," said Dr Ong.
Although she does not have official figures, she estimates that the operation could potentially benefit 50 to 100 people a year who suffer from strokes, Bell's palsy and cancer.
The other five patients, who are Singaporeans, declined to be interviewed.
"There are many different surgical techniques which can help a patient smile again. We customise the surgery depending on the patient's needs, health and age," said Dr Ong (see other report).
Professor Colin Song, head and senior consultant at the department of plastic reconstructive and aesthetic surgery at Singapore General Hospital, said the arrival of "free tissue transfer" technique has made a tremendous change for facial re-animation.
Free tissue transfer involves harvesting a muscle with its nerve supply and blood vessels from a patient, in an area remote from the face, and transferring it to the face as a functioning muscle.
"The nerve and blood vessels are joined by suturing under microscope magnification with very fine stitches," Prof Song said.
The transferred muscle makes the face look more natural.
He said his department carries out such operations on an average of four patients a year.
"All patients are suitable as long as they are fit for surgery. Most importantly is the question of what each patient's expectations are," he said.
This type of surgery does not give normal facial muscle function back to the patient.
The main purpose is to restore symmetry to the face at rest and for the patient not to appear abnormal. Younger patients get better results with this type of surgery mainly because their nerves and muscles recover better," he said.
Although Madam Bao's face has not returned to what it was before her stroke, she is happy with the results of her surgery.
She has learnt to smile again. "The surgery has made my mother feel better and more confident about her appearance," said Ms Yen.
Email: wanching@sph.com.sg
Click for jpeg format
« Back to previous
page
back to top