News Article - Facial Reconstruction After Cancer Surgery

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Submitted by Northwestern Medicine

Posted5/20/2019 9:17 AM

It started with a face twitch. Mary Broderick, of Elgin, didn't think much of it until her face began drooping on one side. After living with a misdiagnosis of Bell's palsy for three years, Broderick was determined to find out what was really going on. An online search led her to Northwestern Medicine cranial base surgeon Dr. Andrew J. Fishman; and finally a correct, but alarming diagnosis.

Broderick had a cancerous tumor in the parotid gland, the main salivary gland. It was intertwined with the facial nerve and causing facial paralysis. Removing the tumor and restoring function would require several microsurgeries at Northwestern Medicine Central DuPage Hospital.

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"The goal is to resolve the droop and achieve symmetry, while also restoring comfort in eating and movement," said Fishman. "Using a combination of approaches, we reconstructed the facial nerve and moved a portion of the muscle that controls the jaw to create lift around the mouth."

During the surgery to remove the tumor, Fishman transplanted a sensory nerve graft from Broderick's lower leg to reconstruct the facial nerve. A few weeks later, he performed an orthodromic temporalis tendon transfer. The microsurgery involves transposing a portion of temporalis muscle, one of the chewing muscles, from the fifth cranial nerve to the facial nerve. The final surgery was implanting a thin weight in the eyelid to help close the eye.

"When Dr. Fishman described the procedure, I thought it was a Frankenstein surgery. My mind was blown," said Broderick. "But when I learned it was cancer, I needed to get it out."

It was a slow recovery. The muscles in the face had to be retrained with physical therapy and the nerve graft takes about a year to heal. Broderick says it was an emotional journey.

"I've come to terms with aging and vanity left me a while ago. But the facial paralysis was so dramatic and I couldn't hide it," said Broderick. "I had lost my identity and sometimes I felt like I couldn't go on."

Broderick was plagued with dreams about losing her wallet or purse. She believes these dreams were a manifest of the feelings that she just couldn't accept. However, over time, the nerves and tissues continued to heal.

At the two-year mark Broderick says she saw a remarkable change. She now has movement of her upper lip, can speak more clearly and her ability to eat and drink has improved.

"People don't stare anymore," said Broderick. "It will never be back to where I once was, but I have accepted the new me and am so grateful to be cancer free and have some restored function."

Northwestern Medicine offers a wide range of treatment technology, including surgical and nonsurgical solutions, for facial nerve disorders, including Bell's palsy, paralysis, spasm or neuralgia. Patients who experience facial tics, twitching, numbness, weakness, pain or paralysis, should undergo a through exam to determine the cause. 

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© Andrew Fishman MD 2019