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Air Force Print News|by Lt. Col. Lesa Spivey
SAN ANTONIO - Patients seeking help for facial paralysis have a new treatment option available now offered by doctors at Wilford Hall Medical Center at Lackland Air Force Base, Texas.
Col. (Dr.) Alan Holck and Maj. (Dr.) Manuel Lopez are among only a few military or civilian surgeons in the country who perform a recently developed procedure called temporalis tendon transfer to treat patients suffering from facial paralysis due to conditions such as trauma, tumors, strokes, cancer, some surgeries and Bell's palsy.
The only other physicians who offer this treatment practice at Johns Hopkins Hospital in Baltimore.
The temporalis tendon transfer surgery can be performed in cases where injury to the facial nerve cannot be repaired or the nerve will not naturally recover. The procedure is relatively simple and straight forward. Only taking about 90 minutes to perform using one small incision (three centimeters), the surgery involves taking the muscle (the temporalis tendon) that controls movement and clinching of the jaw and re-inserting it into the musculature of the mouth (corner of the mouth) to restore movement and function.
The process of this dynamic muscle transfer is a promising option for facial reanimation in patients for whom nerve repair, grafting and nerve transfer are not possible.
"Loss of the facial nerve can be devastating and life-changing. The nerve provides motor movement to the face (overall facial animation). It allows you to smile, chew, close your eyes and raise your eyebrows," Dr. Lopez said.
"From the top of the face down, the problem usually starts at the brow which causes problems closing the eye," Dr. Holck said. "Subsequent drying of the eye can result in infections and loss of vision. The midface droops. The corner of the mouth also descends and, therefore, drinking becomes a problem. Patients will drool and have difficulty eating. Food tends to get lodged in their mouths. You become almost a social leper because you don't want to go out and keep having to get up to go wipe your mouth. And among other issues, the tip of the nose deviates and so it is really a problem. It is most importantly a functional issue but also has a devastating cosmetic component."
In addition to the temporalis tendon transfer, Dr. Holck and Dr. Lopez complete their comprehensive treatment by performing any necessary static procedures (pulling, tightening and lifting parts of the face) that do not involve muscles or nerves. Static procedures elevate and give symmetry to the face.
"An operation we'd do commonly is to elevate the eyebrow and that is a static elevation in which we restore symmetry from a droopy eyebrow to a more symmetric eyebrow. The upper eyelid generally doesn't close when you have a facial paralysis so what we do is put a weight, either platinum or gold, in the upper eye, to help the eyelid close to protect the eyeball. The lower eyelid generally won't have tone either (when the nerve is no longer functioning) so we elevate the lower eyelid to narrow the space between the two, for better closure, and we support it. Those are all standard procedures we've been doing as part of our comprehensive treatment," Dr. Lopez said.
The doctors have been performing the temporalis tendon transfer surgery for 16 months and have successfully treated nine patients.
The course of treatment for each patient is determined by a complete, individualized facial assessment in which each patient's deficits are determined.
"No one gets a blue-plate special," Dr. Holck said.
Milan Maymar, a cancer survivor, has benefitted from the successful treatment he received from Dr. Lopez.
"I was very skeptical at first. After consulting five plastic surgeons, Dr. Lopez was the sixth doctor I came to for help. Dr. Lopez' upbeat attitude, encouragement, skills and confidence quickly made me believe it was possible that something could be done to help me. Now that I've had the treatment, my speech has improved and my eye functions better. The results were even better than I anticipated," Mr. Maymar said.
When asked why only a small number of patients have been treated so far, the doctors said the numbers are not greater due to lack of awareness that the treatment is available. Many times, patients are turned away by other facilities and told there is nothing that can be done for them. However, Wilford Hall's team of doctors wants to get the word out and encourage others needing treatment to seek help.
Historically, the treatments for facial paralysis have not been great or long-lasting. But this new procedure, the temporalis tendon transfer, has proven to be a more efficient and effective method. The surgery takes minimum time to perform and the recovery is rapid with dramatic improvement expected within the first week.
"Patient satisfaction has been tremendous," Dr. Lopez said. "We're passionate about it. Just being able to restore function back to them is extremely rewarding for us."
