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Grinning big: Facial reanimation returns the gift of a smile

OHSU offers a variety of treatment options for people with facial paralysis
Facial reanimation at OHSU
Following a stroke in 2015, Jarmlla "Jarm" Hawes (left) was left with one side of her face severely paralyzed. Myriam Loyo Li, M.D., at OHSU, was able to transfer nerves from one side of Hawes' face and tongue to the other, which eventually allowed Hawes to regain some movement and the ability to smile. (OHSU/Kristyna Wentz-Graff)

When Jarmila “Jarm” Hawes was initially recovering from a 2015 hemorrhagic stroke, she would only leave home for medical appointments to avoid interacting with others.

She couldn’t stand without the support of a walker, her left eye pointed in the wrong direction, and the right side of her face was paralyzed. After months of therapy, she was able to walk unassisted and the eye returned to its normal position.

But, despite this progress, her face wasn’t improving. The sinking, droopy side of her face really bothered her. The right side of her lips were sunken, which created an unintentional partial frown. Some people stared.

“I knew I looked bad when I saw myself in the mirror,” said Hawes, who lives in Vancouver, Washington.

Myriam Loyo Li, M.D. (2018)
Myriam Loyo Li, M.D.

Countless doctors and therapists told Hawes there was nothing that could be done. But then she was referred to OHSU facial plastic and reconstructive surgeon Myriam Loyo Li, M.D., who is also an assistant professor of otolaryngology/head and neck surgery in the OHSU School of Medicine and part of the newly created OHSU Facial Nerve Center.

Loyo Li reanimated Hawes’ face during an April 2016 surgery that transferred nerves from one side of Hawes’ face and tongue to the other. Loyo Li partnered with neuro-otologist Tim Hullar, M.D., an OHSU School of Medicine professor otolaryngology/head and neck surgery who helped mobilize the facial nerve from behind Hawes’ ear to reach the nerves on the other side of her face and tongue. Hawes was able to smile again following physical therapy with Margaret McReynolds, P.T., M.Ed., N.B.C.-H.W.C.

“I feel more confident,” Hawes said. “I have benefitted from the surgery so much.”

OHSU is the only institution in Oregon and just one of a few on the U.S. West Coast that provides this new facial reanimation surgery, which involves reconnecting, transferring and/or replacing existing facial nerves and muscles, as well as transplanting nerves and muscles from other parts of the body to the face. Beyond surgery, other treatment options include physical therapy and Botox injections.

During the past five years, OHSU has cared for hundreds of patients who have paralyzed faces as the result of stroke, head and neck tumors, or Bell’s palsy. But Loyo Li routinely interacts with patients and health care providers alike who don’t know facial paralysis can be overcome.

“I have patients come to me and say ‘I know you can’t do anything, I’ve seen five other doctors who couldn’t help me’,” said Loyo Li, who joined OHSU in 2015 and learned facial reanimation techniques as a surgical resident at John Hopkins Medicine in Baltimore, Maryland.

“I want people to know we can do this,” she added. “There are patients walking around with facial paralysis who’ve been told there is nothing they can do and they have to live with paralysis. But we actually have ways to restore facial movement.”

Loyo Li understands the impact these treatments can have on her patients’ quality of life. For example, without treatment, many patients uncontrollably drool. Being able to better control their faces means patients can more easily dine out and fully participate in other normal activities.

Patients who receive these treatments don’t completely return to the way they were before their paralysis started, however. Hawes now flashes a closed-mouth smile, as opposed to the toothy grin she had before her stroke. And she speaks to the side of her mouth, though this is less pronounced than before her facial reanimation procedure. But the differences like this are often “imperceptible” to most people in casual social interactions, Loyo Li said.

Hawes may not be exactly the same, but being able to smile again is big in her book. She enjoys everyday activities like walking her dog and going kayaking and recently married Ken May, her boyfriend of about 15 years.  Most importantly, she wants others to know treatments exist for facial paralysis.

“I want to let the nurses and doctors know,” Hawes said. “If your face droops down, there are options.”

Other providers involved with the OHSU Facial Nerve Center include optometrist Shane McDonald, O.D., oculofacial plastic, orbital and reconstructive surgeon John Ng, M.D., M.S., F.A.C.S., and otolaryngologist/head and neck surgeon Mark K. Wax, M.D., F.A.C.S., F.R.C.S.

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