The neuroma had already damaged the hypoglossal (XII cranial nerve) and accessory (XI cranial nerve), resulting in paralysis and atrophy of the tongue’s right side and sternocleidomastoid muscle. The surgical procedure to unbridle vagus fibres (X cranial nerve), damaged laryngeal ones causing paralysis of the right vocal cord. Swallowing was impaired to such an extent that all care was focused on preventing the risk of pneumonia ab ingestis (aspiration pneumonia), which lasted for months.
The neurologist's advice about the facial palsy was to wait for at least a year for neural activity to reappear. The EMG however remained silent in all muscles, while the soft tissues were slipping down and rotating relentlessly leftwards. In addition to the changes in appearance, quality of life deteriorated in several other aspects. While drinking from a cup or a bottle, liquids could no more be retained by my incompetent lips. The articulation of words containing the consonant “P”, of which the Italian language has plenty, was defective. In addition, stillness of the paralysed vocal cord contributed to transforming my speech into a sequence of grimaces.
The right eyelid could not close completely and did not blink at all. The cornea required constant protection from injury, for example from water under the shower, removal of a T-shirt over my head, mosquitos, or dust outside. Computer screen, theatre or movies was not possible for more than half an hour at a time, due to the burning sensation in my eye which no drops could relieve.
At the time of my first visit to the Sorensen Clinic, 18 months after my neurosurgery, a weak movement could be aroused by pinching the cheek, as if some muscle fibres still survived. Based on these clinical symptoms (as hope is the last to die), I asked Dr Sorensen to perform a cross-facial nerve graft together with the proposed right sided lift of soft-tissue and fat graft.
Following my surgery, I was so pleased to experience how the facelift raised the right hemiface and the corner of my mouth to the same level as on the left side. Meanwhile the fat graft compensated for the empty muscle space and improved on my eye closure by pushing up the lower eyelid.
Nine months later, I had recovered a light degree of muscle function, but it did not correct my facial asymmetry. In the second surgery, Dr Sorensen used three facial slings collected from my thigh’s fascia lata and gave me back a perfect symmetry. The improvement was not only in aesthetic appearance, the slings also strengthened my cheek and enhanced my speaking and swallowing. A week after surgery I was able to pronounce my own name for the first time in 3 years.
After another six months, a third and final procedure was performed, in where the right upper lip was raised, recreating the nasolabial fold. Combined with this, a minor surgery on the upper and lower eyelid restored a complete closure of the right eye.
It is true that I am “a work in progress” since age-related gravity will continue to move tissue downwards and the unaffected hemifacial muscles will continue pulling across the midline. I will likely need further adjustments in the future. However this surgery, performed in several steps, has been successful in restoring symmetry and function to such a level that I often forget that I had a grade VI facial palsy.