Doctors in Cape Town performed an incredibly rare operation in South Africa last week which involved removing and harnessing a nerve from a 21 year old’s leg and meticulously connecting it to what was left of her right temporal facial nerve.
This was an exceptionally difficult feat which the surgeons managed to pull off successfully and should hopefully result in reversing the patient’s permanent facial paralysis which has severely affected her confidence and quality of life.
Chanel de Wet (21) is full of life and excited about her future, as she should be at her age. Unfortunately, her confidence, self-esteem and quality of life have been severely affected ever since a surgery in 2017 left her with permanent facial paralysis on the right side of her face. She has been unable to smile, move her eyebrow, show emotion, close her right eye (even during sleep) and often struggles to eat and drink.
The young woman, who works for her family’s business, lost control of her facial nerves and muscles after a nerve was damaged during a surgery to remove a schwannoma. Schwannomas (tumors of the nerve sheath) can occur anywhere in the body at any age and are the most common form of benign nerve tumors in adults.
“In the beginning, it really affected me and I lost a lot of confidence. I shied away from taking pictures as I struggled to come to terms with everything that happened,” says de Wet. She explains that not being able to show emotion, particularly not being able to smile, can get one down. “I will be grateful if I can at least smile again someday,” she adds.
In a groundbreaking facial reanimation surgery, rarely performed in South Africa, a team of medical specialists endeavored to reverse the paralysis and give Chanel back her smile, along with other movement in her face.
The seven-hour surgery, which took place on 20 September at Louis Leipoldt MediClinic (Cape Town), involved a sensory nerve being harvested from de Wet’s leg before being microscopically connected to the healthy tissue in face.
At the beginning of the surgery, Professor Louis Hofmeyr – an ear nose and throat surgeon and former chief ENT surgeon for the South African National Defence Force – drilled into de Wet’s temporal bone in search of a healthy portion of the facial nerve while plastic surgeon Professor Frank Graewe – former head of division of plastic reconstructive surgery at Tygerberg Hospital – harvested the nerve from the leg via small incisions. Justus Apffelstaedt – former Professor and Head of Head, Neck and Breast cancer unit at Tygerberg Hospital – successfully removed the superficial part of de Wet’s parotid gland which covers the facial nerve as it divides and meticulously located the nerve ends responsible for the facial muscles being able to function.
Professor Frank Graewe then connected the harvested leg nerve to the facial nerve ends.
Apffelstaedt, specialist surgeon with an interest in breast, thyroid and parathyroid health as well as soft tissue surgical oncology, described the surgery as “extremely stressful” as nerve branches are naturally minuscule and, in de Wet’s case, they were even smaller due to the atrophy after interruption at the prior surgery. “This surgery requires knowledge and long experience of where the individual branches could leave the parotid gland as the anatomy is highly variable,” he says, adding that a good, tremor free hand is a necessity when performing operations under magnification with surgical loops and microscopes.
“This situation could have been avoided had the first salivary gland surgery been undertaken correctly”, says Apffelstaedt. Many South African patients with this kind of condition are often advised to seek assistance in America due to the complexity of the surgery. “Not many doctors in SA have endeavored to perform this surgery due to the intricacies involved,” adds Professor Frank Graewe.
The surgical team regarded the surgery as successful, however will have to wait for up to a year to see the results as the nerve regeneration process is slow. The chances of de Wet regaining full facial movement are approximately 50 percent – odds she and her family will happily take in order to see that smile once again.
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