A 17-year-old girl who was never able to smile or close her eye freely can now do so after surgeons at the Galilee Medical Center performed two microsurgical operations to fix the problem – nine months apart – for the first time in Israel.
The girl, who lives in a Western Galilee settlement, suffered from congenital paralysis of her left-side facial nerve, which caused facial asymmetry and her inability to perform basic actions on that side, such as smiling or closing an eye. The complex surgery was aimed at restoring function of her facial expression muscles and her lower eyelid.
The “facial reanimation” operations were performed by Dr. Amin Abu Jabal, director of the microsurgery unit and a senior physician in the plastic surgery and burns department at the hospital in Nahariya. He did the complex surgery in collaboration with Dr. Ohad Ronen, director of the head-and-neck-surgery unit in the otolaryngology (ear, nose and throat) department and Dr. Yanir Kassif from the ophthalmology department.
What was the surgery and why was it needed?
The microsurgery took place in two stages. In the first, the doctors removed a sensory (sural) nerve that is about 30 centimeters long, from the back of the patient’s leg, and divided it into two.
They transplanted one part from the area of the patient’s right cheek, with a connection to the nerves on the normal side, to the paralyzed left side. Then they transplanted the other part from the lower right eyelid on the normal side to the paralyzed left eyelid. The nerve was passed through a subcutaneous (below the skin) canal above the bridge of the nose and connected to the nerves of the lower eyelid on the normal side. The first operation lasted five hours, and after a two-day hospitalization, the girl was sent home.
The second stage of the operation took place nine months later, after the nerves had grown in the area of the paralyzed cheek. During this operation, which took about eight hours, a long, thin muscle called gracilis was taken from the upper inner thigh area along with the blood vessels and the muscle nerve. The doctors then implanted the muscle in the paralyzed left cheek and connected it to the corner of the mouth and the area of the left temple.
Then, for the first time in Israel, they transplanted a thin muscle graft to the lower eyelid, which connected to the previously transplanted nerve. The operation went well and after a week’s hospitalization, the patient was sent home.
“This was a unique and extremely complex operation that required high skill in the field of microsurgery. During the operation, for the first time in Israel, we transplanted nerve and muscle into the paralyzed lower eyelid, while connecting it to the nerve that was transplanted in a previous step.”Dr. Amin Abu Jabal
“This was a unique and extremely complex operation that required high skill in the field of microsurgery. During the operation, for the first time in Israel, we transplanted nerve and muscle into the paralyzed lower eyelid, while connecting it to the nerve that was transplanted in a previous step,” said Abu Jabal.
“Most often, this type of surgery is performed on patients suffering from facial nerve palsy, either as a result of congenital paralysis (as was the case here) or due to trauma, surgeries or strokes that caused the paralysis.”
After a follow-up period of one year, the operation has been declared a great success, and now the teenage girl can smile spontaneously and close her left eye freely for the first time in her life.
The microsurgery unit was established about two years ago at Galilee Medical Center and recognized by the Health Ministry. Microsurgery deals with the transfer of tissues with vascular and nerve connections, under a microscope, including transfer of tissue from one part of the body to another (free-tissue transfer) to restore or preserve an organ that is in danger.
So far, the unit has performed more than 50 micro-surgeries, most them involving head, neck, breast and lower limb reconstructions.