کد خبر: 269397
How adults with facial paralysis regain their smiles
So much is said with a smile it's a universal mode of communication that most of us take for granted. But Luigi Quafisi lost the ability to smile because of a benign tumor called an acoustic neuroma that was located near his ear.

"Oh, he had a beautiful smile," his wife of 43 years, Eva, told CTV News.

"He was always happy … and did smile a lot before, yeah."

An acoustic neuroma is a slow-growing tumor that develops on the main nerve leading from the inner ear to the brain. As it swells, it can lead to hearing loss, and disrupt facial function.

Quafisi was diagnosed when he was 63. The tumor damaged the muscles and nerves in his face, leaving him with trouble blinking, eating and smiling. He couldn't even crack a grin for his six grandchildren, who often visited.

Brain surgery removed the tumor in 2017, but it couldn't repair the damage the tumor had already done.

Quafisi said the loss of movement in one half of his face was hard to deal with. "It bothers me a lot," Quafisi said. "I cannot do what I did before."

But a Toronto doctor and a rare procedure offered him the chance to restore his lost smile.

Only a few doctors in Canada offer what is called "facial re-innervation" for adults, and Dr. Heather Baltzer of the Toronto Western Hospital is one of them. To her, a smile is more than just a smile.

"It changes how you interact with your environment and it also changes how people perceive you and speak to you," she added.

Baltzer, trained as a hand surgeon, first began taking on patients for facial re-innervation in 2016. Her first patient, a woman close to her own age, named Anastasia had lost her smile to a tumor like Quafisi.

It's emotional work for her. But when the hard work is over, she gets a unique payoff. "When you see them smile for the first time, it is the best feeling," she said.

Facial paralysis can be caused by injury, tumors or Bell's palsy, and it takes a toll, often leading to depression and isolation.

Baltzer said that those who have lost the ability to smile feel the disconnect of being unable to present their emotions the way they used to, and the way others expect them to.

"It makes a lot of patients feel very isolated, and it stops them from wanting to interact, outside of the home," she said.

She added that often they "tend not to see friends because they are worried about how they're going to be perceived.

"So that's probably a main thing [that] really impacts their quality of life."

In 2018, Quafisi came in for his first facial re-innervation surgery.

He had a typical type of facial paralysis, Baltzer said, where there is a droop in the features on one side of a person's face, and they're unable to close the eye on the affected side.

"The inability to smile on that side of his face as well impacts other functions like the ability to chew food, and to breathe through that side of the nose," she said.

But although she'd seen this paralysis many times before, one of the differences between Quafisi and some of her other patients was his age.

"Because Luigi is a little bit older than some other patients … that impacts [the] way that nerves can regenerate and the time that it takes for nerves to regenerate," Baltzer said.

The type of surgery Baltzer specializes in for adults is more commonly done in children.

There were two main focuses for Baltzer and her team in approaching Quafisi's facial surgery: Bringing back his smile, and restoring eye closure.

In order to do a cross face nerve graft, first they identified the nerves on the unaffected side that controlled smiling and blinking.

Then, they needed to replace the damaged nerves on the paralyzed side of the face.

"We take nerve from another part of the body," Baltzer said, "and that acts like an extension cord running from the normal side of the face to the affected side of the face."

Baltzer took a nerve from Quafisi's leg and carefully inserted it into his face, connecting it to the healthy nerves on the unaffected side.

This type of surgery doesn't instantly restore function to the damaged side, but new nerve fibers can begin to grow. It&