Where Discovery Creates Hope

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When you have a facial injury like this, it smashes the picture that people have of you and you of yourself.
Dr. Jakub Tolar
Dean of the University of Minnesota Medical School
a monthly series

where discovery creates hope

Her Smile Is Back, And How This Young Patient Can Pay It Forward

“Oh, I can’t look at that,” 26-year-old Brianna Eli winces when she sees a photo taken of her just before surgery.

Much of the left side of her face was paralyzed, making it difficult to eat, drink, blink, talk and even smile.

Now, two years into recovery from a nerve transfer, Brianna boldly shares her story in front of a camera.

Even better, the North Dakota native will soon put her experience to work as a nurse practitioner.

Says Dr. Sofia Lyford-Pike, the facial plastic and reconstructive surgeon from the University of Minnesota Physicians Hilger Face Center who got Brianna to smile again: “She’s going to be able to empathize with patients in a way that I simply can’t.”

“It was scary,” Brianna says. “Very scary.”

A benign tumor growing on the nerves in Brianna’s left ear was the root cause of her paralysis. Doctors successfully removed the growth, but there were complications.

“There was really no way to save the hearing,” Brianna says. Plus, the nearby nerve feeding some of the muscles on the left side of her face never recovered.

Doctors referred her to Dr. Lyford-Pike – chief of the University of Minnesota Medical School’s Division of Facial Plastic Surgery.

“The way I describe it to patients,” she says, “is we have to rewire their faces.”

Adds Brianna: “I didn’t even know that was an option until meeting her.”

You Can’t Put A Shirt On – And Hide The Scars

Nothing animates Dr. Lyford-Pike quite like talking about the stigma of facial paralysis.

Because her patients’ condition isn’t life-threatening, people often think vanity is the only reason they’d seek help.

Nothing, Dr. Lyford-Pike insists, could be further from the truth.

Our faces are how people see – and judge – us. They’re how we see – and judge – ourselves. And with just one simple look, faces can do what a thousand words often can’t.

What if, for example, you couldn’t express joy?

We Sew One Branch Of Nerve To Another

Twelve nerves - numbered, simply enough, one to 12 - exit the skull to provide different functions. Cranial nerve seven powers the muscles of the face.

Brianna’s number seven took the hit, Dr. Lyford-Pike says. It controls things like elevating a brow, closing an eye, scrunching a nose and making that disarming smile.

In a five-hour microsurgery, Dr. Lyford-Pike used a tiny needle and thread to borrow movement from other nerves.

For instance, to get that smile for Brianna, Dr. Lyford-Pike hooked into a branch of the nerve feeding the chewing muscle.

Says Dr. Lyford-Pike: “It’s really a testament to how adaptable, or ‘plastic’ the human body is.”

She Wears Hope On Her Face

Through physical therapy, Brianna learned how to move her rewired face again.

One of her earliest lessons: To smile, bite down.

Now, in a tribute to how adaptable our brains are, Brianna can smile by simply thinking it.

“That’s exciting,” she says.

Observes Dr. Lyford-Pike: “She’s on the next level of neuroplasticity.”

“I Feel More Like Myself Again,” Brianna Says.

Throughout all this medical care, Brianna never missed a beat at school.

She continues to see Dr. Lyford-Pike for Botox injections “on the right side of my face to kind of even it out a little more.”

As Brianna ages, there may be other tweaks as well. But nothing that will stop her from showing patients “there’s hope.”

Says Dr. Lyford-Pike: “This is the type of experience that makes someone withdraw, lose themselves, have a hard time. To have a patient sit in front of a camera is an incredible win. I don’t want to cry, but it’s an incredible privilege to be a part of this.”

PUTTING DISCOVERY INTO PRACTICE

M Physicians are an extension of the University of Minnesota Medical School. As Medical School faculty, they are always looking for new and better ways to treat patients, whether in the laboratory or the clinic. And through clinical trials, cutting-edge therapies are sometimes available to patients when the standard of care is no longer enough.

What is Academic Medicine?

Most medicine is practiced within what is called “the standard of care.” Simply put, “standard of care” is the treatment that is commonly accepted for treating illness. This is a good thing! It means that patients receive treatments that are known to be generally effective and reliable.

The goal of academic medicine is to treat patients while looking for better therapies. It takes the toughest problems from the clinic and looks for solutions in our research. Many of our physicians — leaders in their fields — are also scientists.

When a patient faces an illness that requires treatment that exceeds the standard of care, academic medicine can provide access to newer therapies.

Sofia Lyford-Pike, MD
Sofia Lyford-Pike, MD
Facial Plastic and Reconstructive Surgeon, University of Minnesota Physicians Hilger Face
Center and M Health Fairview
Associate Professor, University of Minnesota Medical School
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