facial paralysis

40 years Post-Op: Rosaline's Story

joanne — Wed, 19 Jan 2022 23:51:43 +0000

40 years Post-Op: Rosaline's Story joanne Wed, 01/19/2022 - 18:51

Rosaline Christensen was 39 years old when her AN was diagnosed. This is an excerpt from her memoir "Walk"

Rosaline Christensen

My husband Casey and I were out for an evening walk when I felt a sharp pain in my left ear. The next day I made an appointment with an ENT. He said, “You could have an acoustic neuroma. Come back in six months.” I went into denial. No way! Foolishly, I didn’t go back for more than a year and when I finally got there, he confirmed his earlier suspicion that it was indeed an acoustic neuroma. He referred me to Dr. Griesdale, a neurosurgeon at St. Paul’s Hospital in Vancouver, B.C. (Dr. Griesdale passed away in 2010)

I was thirty-nine years old, stood five feet four inches tall, weighed one hundred and twenty-five pounds, had blonde hair, and hazel eyes. Some people would say my smile was infectious and that my whole face lit up when I smiled. This changed after surgery. Instead, people looked away, or down at the ground, pretending they didn’t see my crooked face. A few asked if I’d had a stroke.

Dr. Griesdale greeted us at the door with a warm handshake and later said he too was thirty-nine years old. I had imagined a neurosurgeon as being old. Instead, his stature was youthful and sturdy, instead of grey or balding hair, it was brown, nicely cropped, and curly. He pointed with a pointer stick to the CT scan that hung on the screen behind his desk. There was a lighter image, in the shape of a golf ball, hovering above the brain. He said, “See it there? What you have is an Acoustic Neuroma. It’s about three and a half centimeters in diameter. It’s growing on the eighth cranial nerve and it touches the seventh nerve.”

He explained there were two options: one was to leave it and let it grow, the other was to surgically remove it, then he quickly added, “YOU have no choice but to opt for the surgery because you have a two-year-old daughter at home. If you let it grow, you could become incapacitated.” He said, “The surgery is lengthy and delicate, anywhere from twelve to twenty- four hours, and because they are so long I only do them on Mondays and Wednesdays. We WILL sever the eighth nerve and as a result, you will lose your hearing in the left ear. There is a fifty percent chance the seventh nerve will be damaged causing permanent facial paralysis.”

I had no comprehension of the loss and change involved in having unilateral hearing and facial paralysis. He neglected to mention possible residual effects of cognitive, vestibular, and left eye damage.

Unshaken and to my later embarrassment, I asked, “Will I have to have my head shaved?”

He said, “yes, your head will have to be shaved, but I’ll do it personally when you are under anesthetic.” I replied, “Thanks, and I’d like to have it done on a Wednesday, just in case you have a weekend party.” How cheeky of me!

Casey and I went down the elevator to the sidewalk, we silently walked to the car. I looked up through the tall buildings to the sky above. I felt like a tiny speck in a very big universe. We said nothing until midway home when I looked over to where he sat in the driver’s seat and with tears in my eyes, I said, “I guess it’s malignant.” I’d never heard the word tumour unless it referred to cancer. The color drained from Casey’s face, his chin quivered as he said, “I don’t think so. I will give Dr. Griesdale a call in the morning and ask.” It was benign.

The night before surgery, I was very nervous. Dr. Griesdale came into my room and sat at the end of my bed. He went over the procedure and reassured me he would shave my head in the morning after I was asleep. I bathed as instructed, and as I lay in bed I reached for the Bible in the bedside stand. I thumbed through the pages until I settled on a verse, Isaiah 40:31 - “They that wait upon the Lord shall renew their strength; they shall mount up with wings as eagles; they shall run, and not be weary; they shall walk, and not faint.”

The next morning a nurse came into my room and said, “It’s time.” She transferred me from my bed onto a stretcher, and wheeled me to the operating room door, and left me there. I lay alone and waiting. I tightly clutched a brown washcloth to my chest like my security blanket. Soon they wheeled the stretcher under bright lights and transferred me onto the operating room table. People dressed in green were scurrying about. Someone said, “You’ll feel a prick as I start the anesthetic.” “Now, start counting from one to one hundred.” I think I got to eleven . . .

My childhood friend Lila came to visit me in intensive care, and as always, the essence of our friendship was laughter. My left eyelid hung wide open and didn’t blink. Without tear production, it was very dry and very painful. I held my hand over my eye. Lila grabbed a damp washcloth and plopped it on my eye. It kept falling off to the side, she wrapped it around my nose saying, “There, now that’s putting that big nose of yours to use.” We laughed.

It was October 7, 1981, I had a fifteen-and-one-half hour surgery. It was autumn, and the leaves were changing color. The landscape was changing and so was I. The lengthy surgery and long recovery left me with significant changes. It had a huge effect on me and my family. My children lost the mother as they knew her. My husband lost the wife he married. It was like a death that none of us were ready for. Grief never occurred because I was still alive.

The transformation pushed me to face the truth of an unhappy marriage. Eleven months after surgery, my twenty-plus-year marriage came to an end. My recovery took two years after which I took up the challenge of going to university and getting myself into the workforce as a pre-school teacher. I’d been an at-home mother for over twenty years. I could have gone back to work in the hospital where I worked before having children. The personnel officer said there was work for me, but I knew my cognitive ability was not what it was before surgery. I chose not to accept her honourable offer.

Now, forty years later I still struggle with the severe dry left eye, and visual memory loss. Frequently forgetting words and where I’ve left things. Keeping a writing pad near at hand, and writing things down helps. Leaving visual markers, here and there, is helpful. Often when I would be madly searching for an item my daughter would giggle and say, “I guess the cat took it.”

When I worked with children, one day a little boy was sitting on my knee, he looked up at me and said, “Why do you wear an ear-ring in that ear when it’s broken?” I immediately took that earring out. The children henceforth came to the side with the earring, the side that in children’s terms, the ear that worked, my hearing ear.

A favorite quote from a favorite person of mine – M.K. Gandhi: “I do not believe India to be helpless...I do not believe myself to be a helpless creature...Strength does not come from physical capacity. It comes from an indomitable will.” Yes, I had an indomitable will.

My eldest son’s wise words to me were, “Mum, your willfulness needs to become willingness”. Thank you, son, thus I learned to let go, let go, and let go of my willfulness, and became willing to accept my limitations along with my strengths.

If I were to offer words of inspiration they would be: Believe in yourself and the universe and keep putting one foot in front of the other even if you wobble when you walk.

If I were to choose a word to share it would be - ‘remember’. Remember our life lessons, remember gratitude, and remember love.

“Life is our teacher. Love is the answer.” R.F.C. © February 2021

www.expressionsbyrosaline.com

Rosaline lives with her P.A.D.S. (Pacific Assistance Dog Society) hearing dog. She believes we connect through story and through story we do not feel alone. In retirement years it seems a natural progression for her to transition into writing. She hopes that writing and sharing her life story, “WALK” will give others encouragement and hope.

facial paralysis

hearing

surgery

Tumour of Opportunity: Brittany's Story

joanne — Mon, 30 Aug 2021 21:28:20 +0000

Tumour of Opportunity: Brittany's Story joanne Mon, 08/30/2021 - 17:28

Brittany Blanchard was only 25-years-old when she was diagnosed with an AN. She used her experience to her advantage and is now a Hearing Instrument Specialist.

Brittany Blanchard

In early 2017, I had never heard of an acoustic neuroma, nor considered that one day I would be having brain surgery. By the end of 2017, I was living a totally different life! This is the story of how a tumour, which almost stole my life, instead ended up illuminating my path to success.

In January 2017, while watching TV, I suddenly realized, I think I’m losing the hearing in my left ear. With that ear on a pillow, I was able to hear well; however, with my right ear on the pillow, I was unable to hear any sound on the TV. Concerned, I spoke to the only person I knew who wore hearing aids. She told me about a nearby clinic where I could have my hearing tested . . . I was only 25-years-old!

A few weeks later, I started having tinnitus in the left ear, so I scheduled a hearing assessment at the clinic. It was almost two months since I first noticed my hearing loss, and three weeks since the unilateral tinnitus first began. Upon filling out the case history form, I came across a question about vertigo, something I had developed about five years prior, but never looked into as it was so mild. Seeing it on a form for a hearing test, I found both intriguing and disconcerting.

The results revealed normal hearing in my right ear, with a mild loss in the high frequencies, and a mild hearing loss in the left ear, with a severe loss in the high frequencies. I was then referred to an ENT, who retested my hearing. As there was further decline, the ENT ordered an MRI. During the MRI, they pulled me out and said they had to inject me with dye so they could see more information in my brain. This is when I knew something was really wrong.

Three days after my MRI, I learned that I had a very large acoustic neuroma and required brain surgery. The ENT referred me to Dr. Izukawa, a neurosurgeon in Mississauga, and to Dr. Joseph Chen, ENT surgeon. I had my first appointment with Dr. Izukawa in August 2017. He showed me and my parents the MRI images revealing my 4.5 cm tumour, which was crushing my brain, bending my brainstem, and pressing on my optic nerves. He told us that although this tumour is benign in nature, its sheer size was threatening to snap my brainstem. To put into perspective just how large this tumour was, it was about a quarter of the size of my brain.

I met Dr. Chen for the first time ten days before the surgery, in October 2017. Having lived with the knowledge of my tumour for a few months, I had had a chance to tell my family and friends about it. Naturally, they wanted to discuss it extensively and the word “tumour” became a source of panic in itself. As a result, I decided to give it the least threatening name I could think of, Winnifred!

Dr. Chen informed my mother and I that he would be severing my 8th nerve on the left side, and I would become permanently 100% deaf in that ear. Due to the size of my tumour, there was also an extremely high chance that he would have to sacrifice my 7th nerve, which would result in the left half of my face being paralyzed. As a now 26-year-old woman, I was devastated, terrified, and lost. Although I was surrounded by love, I felt alone and isolated. I had had reconstructive knee surgery a year prior and comforted myself by thinking, “at least it’s not brain surgery!”. And then it was.

The morning of the surgery, I woke up feeling an almost unsettling sense of calm, likely because, for about three months, I was afraid to sleep because I did not know if I would wake up or not. My dad picked me and my boyfriend up at 6 a.m. to drive us to the hospital where we met my mom and grandmother. Walking to the operating table was surreal. As I climbed onto it, I couldn’t help but think, “this is brain surgery . . . I might not leave this table alive.” My wonderful little support team patiently waited 12 hours while I had the tumour removed.

Although I was dizzy, no longer had hearing in my left ear, the left side of my face was paralyzed and my vision was impacted, I was grateful for the surgeons and the nurses who took care of me.

About six months post-op, I was fitted with a CROS system, and my life changed again. I fell so deeply in love with my hearing aids that, within a few weeks of wearing them, I registered for college to become a Hearing Instrument Specialist. I knew that I had to help other people. Just ten months after surgery, I was sitting in a classroom. Still experiencing dizziness, and having to undergo surgery to correct vision complications, I had the feeling that I may have rushed myself. Nevertheless, I knew I had made the right decision because helping people has always been a passion of mine, but I had not been able to decide on a career . . . until now.

I graduated in April 2020, completed my internship and passed the International Licensing Exam in 2021. I am now a certified Hearing Instrument Specialist, on top of being an acoustic neuroma survivor. My next goal is to support other young individuals diagnosed with this tumour and ensure that they never feel they have to face this diagnosis alone.

My acoustic neuroma threatened my life but, with the help of my family, friends, and phenomenal surgeons, I overcame it and have now been tumour-free for four years! It is extremely easy to feel alone when you have an acoustic neuroma, so it is fantastic that there is an entire community for support within ANAC!

facial paralysis

hearing

tinnitus

Lessons Learned: Anna's Navigation through her AN Diagnosis

joanne — Mon, 01 Feb 2021 15:33:35 +0000

Lessons Learned: Anna's Navigation through her AN Diagnosis joanne Mon, 02/01/2021 - 10:33

Anna Gurdon is an ANAC board member who learned some valuable lessons navigating through her AN diagnosis.

Anna Gurdon

Arriving at an AN diagnosis often requires the “Squeaky Wheel” approach. After a boating accident in 2012, I immediately developed tinnitus and muffled hearing on my right side. I did go see my family doctor as well as an ENT specialist, but unfortunately there was no official diagnosis. My symptoms showed signs of a concussion as a result of the boating accident. As the years went on, I noticed my hearing getting worse, the tinnitus was unbearable some days, and I was getting headaches all the time.

Once again, I followed up with my doctor in 2016, who sent me to a second ENT specialist. My symptoms were again related back to the accident. Although the loss of hearing was noted, nothing further was investigated.

In January 2019, I went back to my family doctor and expressed, “something is really wrong with me”. I re-explained my symptoms and shared with my doctor, “I feel like I have a bad day, every day”. At the same time, I continued to do my own research, and everything pointed to an Acoustic Neuroma. When I had a third ENT specialist appointment, I went in telling him that I think I have AN. He gave me some validation and ordered a balance (VNG) test, and an MRI. The immediate data from the VNG test indicated my balance was significantly compromised. Both tests eventually confirmed my suspicion, and I was officially diagnosed in August 2019 with an acoustic neuroma. It was 2.2cm in size.

Like everyone, I was overwhelmed with emotions and not sure on next steps. I just kept thinking, how can this happen? We have so much going on at home. I have two teenage children, a very stressful job, and so many family commitments. What are we going to do? I didn’t want this to change my world. My husband and I decided to talk to the kids and the extended family; we told them what was going on and used the ANAC website to help explain the issue. Our kids were old enough to understand the severity, and we assured them that I was going to be just fine. I also talked to my work, and they were extremely understanding. I decided to slow down at work to part-time, affording me time to do some research, attend appointments, and take some time to myself.

Thankfully, I also had ANAC to help. I reached out and had a very lengthy conversation with Carole Humphries, Executive Director about my diagnosis. Timing worked out for me; that week there was a support group meeting which helped me understand my prognosis and options.

I was referred to Sunnybrook, and had appointments with two surgeons. I learned that the two best options, based on my age, tumour size, and amount of hearing loss, were either radiation or surgery. The approach for surgery was explained in detail. After my appointment, I did my own research and elected to undergo surgery using the translabryinthine approach. Accepting the fact that my hearing was not serviceable, and that I would be single sided deaf (SSD), was not an easy pill to swallow.

In the months leading up to surgery, I prepared as much as possible. I exercised daily, prepared freezer meals, arranged a support system to help with the kids and their sports commitments, while I was recovering. Thankfully I have an amazing, caring, and understanding family, all willing to help.

My surgery was on December 5, 2019 and lasted 8 hours. We couldn’t have asked for a better outcome. The full tumour was removed and the facial nerve was preserved. I am forever grateful to the team of surgeons, nurses and medical staff at Sunnybrook Health Sciences Centre.

One week post-operatively, I developed mild facial paralysis. My right side showed signs of palsy, with difficulty to blink my eye, and a sloped smile. During my post op appointment, I was advised it was temporary and would go away with warm compress and massaging. This all happened during the holidays, so I did my best to still attend family gatherings. However, it was only three weeks post-op so I was fatigued and felt a little awkward with the facial palsy. At the fourth week, I really feel like I made a turnaround. On New Year’s Eve, we celebrated and I went out for dinner with my family.

My recovery consisted of long walks every day and going to the mall before it opened and doing laps of power walking. By the sixth week, I returned to the gym: did longer walks on the treadmill; increasing intensity; introduced gentle yoga and engaged in social activities with friends and family. I started to re-gain my balance and also saw a vestibular therapist. In addition, I returned to normal parental activities by driving my kids to and from school and attending their competitive sports games.

The SSD has taken some time to get used to, and I can honestly say that at ten weeks post-op I am still not completely used to it. I have learned to use an ear plug in noisy situations such as my son’s hockey games. In social settings, I selectively pick my seat knowing that I can’t hear out of my right side. As well I have learned to be honest with colleagues and friends by telling people upfront of my SSD, or telling people to have one conversation at a time.

Finding out about your AN diagnosis and options is not an easy process, but going through this has taught me some very valuable lessons.

Be an advocate for your own health and get a second, sometimes third opinion.
Use a support system of family and friends, and be thankful for their love and support.
ANAC is an excellent resource for help, and their services are invaluable too.
We are lucky to live in Canada; we have access to excellent health care.

My greatest advice and learning from all this are to embrace the change, do your research, and find your new normal. It won’t be easy, but please remember there is support.

Scleral Contact Lenses for Patients with Acoustic Neuroma and Facial Nerve Palsy with or without Corneal Anesthesia

admin — Fri, 31 Jan 2020 21:03:21 +0000

Scleral Contact Lenses for Patients with Acoustic Neuroma and Facial Nerve Palsy with or without Corneal Anesthesia admin Fri, 01/31/2020 - 16:03

Background

The cornea is the normally transparent, clear window of the eye. Possible sequelae of acoustic neuroma surgery include facial nerve palsy with or without corneal anesthesia, both of which can severely compromise corneal comfort and integrity required for clear vision. The facial nerve innervates closure of the eyelid and facial muscles.

With facial nerve palsy, the lower eyelid may be everted (ectropion), and the eyelids may not close completely (lagophthalmos). Since the cornea requires constant moisture and protection, facial nerve palsy may lead to corneal breakdown (keratopathy), corneal opacification and infection, with loss of vision and or discomfort ulceration. The first branch of the trigeminal nerve innervates the cornea and provides important nutritional factors and protection for the eye.

Traditional methods for corneal protection after facial nerve palsy or trigeminal anesthesia include frequent lubrication, moisture chambers, tarsorrhaphy (sewing parts of the upper and lower lid together), punctal occlusion, upper lid gold weights and springs. A newer surgical intervention to restore corneal sensation is corneal neurotization, but this procedure requires a donor graft, may require a year to work, and is not always successful.

Over the last decade, an increasingly popular non-surgical method to protect the cornea in patients with facial nerve palsy with or without trigeminal anesthesia is the gas-permeable scleral contact lens (SCL). SCLs are much larger than conventional contact lenses, and rest on the less sensitive white of the eye (sclera) rather than the cornea. A saline solution fills the space between the cornea and the SCL, keeping the cornea moist. These lenses have several advantages over tarsorrhaphies, which are cosmetically unappealing and can limit peripheral vision. SCLs offer much better aesthetics than tarsorrhaphy, and can optimize vision, especially in patients with corneal scarring.

Some Canadian optometrists who belong to the Scleral Lens Education Society are found at the website: https://sclerallens.org/find-fitter/?country=Canada

Scleral Contact Lenses

All eyes are shaped uniquely, and as such SCL require customized fitting and measurements of the front of the eye. (Russell, 2016). This process is conducted by an optometrist or contact lens fitter with specialty training in SCL fitting. The initial fitting process may take an hour, and training to learn to insert and remove the SCL may take more than an hour (Woo, 2014). Patients are often dispensed lenses within weeks of the initial fitting, but completion of the custom lens may take several months to finalize.

Of note, due to the lengthy customization of SCLs, they are more costly than conventional lenses. Patients should contact their medical/vision insurance company to determine if they have benefits that may cover a portion of the cost of fitting and/or of the SCL themselves. A letter from their ophthalmologist or optometrist may be required to show proof of medical necessity.

Prior to SCL insertion, non-preserved saline is used to fill the entire lens. (see Figure) To ensure the solution does not spill out of the lens, patients must tuck in their chin while looking down usually into a mirror. One hand is used to open the eye fully and the other hand is used to insert the lens. A scleral lens suction cup (see Figure) is most commonly used to place the lens on the eye.

Scleral contact lens maximally filled with saline positioned on a “DMV” suction cup (blue).

Alternate methods include positioning the fingers into a tripod to balance and insert the lens, but patients often find this method more challenging. For patients who have great difficulty with insertion, a stand may be used so the hands are both free to hold the lids open.

If too much of the saline spills out, a bubble will form between the lens and the eye. In this case, the lens will have to be removed and re-inserted. To remove the lens, a removal plunger should be used. Patients should be proficient at putting the lenses on and taking them off prior to taking the lenses home. There are many assistive tools to facilitate insertion and removal of SCLs, including application and removal plungers, plastic rings, and stands. These can often last up to three months and can be purchased at contact lens fitter’s office. Whether an assistive device or fingers are used for application, SCL wearers should insert the lens and then release their eyelids before letting go of the lens.

When scleral contact lenses are properly cleansed and adequately maintained, they may last up to two to four years. The gas-permeable material allows for oxygen to readily pass through the lens to maintain the health of the eye. The lens protects the surface of the eye from environmental factors, hydrates the surface of the eye, while correcting irregular astigmatism caused by corneal scarring

To ensure proper long-term use of the SCL, follow-up appointments are booked every one to two weeks until completion of the fitting. Ultimately, the goal is to have a properly fitted lens that does not compromise the cornea or conjunctiva and provides optimal vision and comfort for the patient. Orange coloured eye drops (fluorescein) are often used to examine the presence and quality of the tear film between the lens and the eye.

The amount of time a patient can wear the SCL varies from patient to patient. Typically, patients with facial nerve palsy are encouraged to wear the SCL during all waking hours to protect the cornea and ocular surface. All contact lenses including SCL should not be worn at night to decrease the risk of corneal infection. In patients with facial nerve weakness, taping the lids closed, nighttime lubricating ointment and moisture chambers are advisable alternatives. If patients have an upper lid gold weight, the head of the bed should be raised to help the lids close at night.

Corneal infections are a potential risk with SCL, but the risk is minimized with good lens and hand hygiene. In a large study of over 84,000 patients who were fitted for SCLs, there were only 70 cases of reported infected corneas. Wearing contacts overnight (even gas permeable lenses) can lead to the eye being starved of oxygen. Other complications include corneal swelling, new vessel growth in the eye, conjunctival redness, fogging, and dryness of the lens during the day.

In summary, SCLs are non-surgical options in acoustic neuroma patients who have corneal exposure and/or loss of corneal sensation. SCL can help protect and heal the ocular surface, recover vision, and reduce pain for patients with facial nerve palsy. However, SCL needs to be worn appropriately and checked regularly to avoid corneal infection or other ocular surface compromises.

References

DeLoss, K. S., Kaz Soong, H. & Hood, C. T. (2019). Complications of contact lenses. Trobe, J. & Givens, J. ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed June 29, 2019).

Fadel, D. & Toabe, M. (2018). Scleral Lens Issues and Complications Related to Handling, Care Compliance. Journal of Contact Lens Research and Science, 2(2), 1-13. DOI 10.22374/jclrs.v2i2.24

Griffin, G., Fey, A. & Azizzadeh, B. (2017). Facial Nerve Palsy. In A. Fey and P. J. Dolman (Eds.), Diseases and Disorders of the Orbit and Ocular Adnexa. Retrieved from Elsevier ClinicalKey.

Lasby, A. (2016). The Scleral Lens Industry: Where are we Headed? Canadian Journal of Optometry, 78(1), 32-35. Retrieved from https://opto.ca/sites/default/files/resources/ documents/cjo_contact_lens_supp.pdf

Michaud, L. & Liao, J. (2016). Scleral Lens Troubleshooting Q&A. Canadian Journal of Optometry, 78(1), 25-31. Retrieved from https://opto.ca/sites/default/files/resources/ documents/cjo_contact_lens_supp.pdf

Russell, B. (2016). Visual Rehabilitation with Contact Lenses for Irregular Corneal Astigmatism. Canadian Journal of Optometry, 78(1), 4-17. Retrieved from https://opto.ca/sites/default/ files/resources/ documents/ cjo_contact_lens_supp.pdf

Scleral Lens Education Society. (2018). Patient FAQs. Retrieved from https://sclerallens.org/for-patients/patient-faqs/

Weyns, M., Koppen, C. & Tassignon, M. J. (2013). Scleral Contact Lenses as an Alternative to Tarsorrhaphy for the Long-Term Management of Combined Exposure and Neurotrophic Keratopathy. Cornea, 32(3), 359-361. DOI:10.1097/ICO.0b013e31825fed01

Zaki, V. (2015). A non-surgical approach to the management of exposure keratitis due to facial palsy by using mini-scleral lenses. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC5312998/

Woo, S. L. (2014). 10 Dos and Don’ts of Scleral Lenses. Retrieved from https://www.reviewofcontactlenses.com/article/10-dos-and-donts-of-scleral-lenses

Dr Edsel Ing

Edsel Ing MD, FRCSC, MPH is Associate Professor of Ophthalmology, University of Toronto and is the full-time preceptor of the oculoplastics, strabismus and neuro-ophthalmology fellow at Michael Garron Hospital. He is a member of the American Society of Oculoplastic and Reconstructive Surgery, the Canadian Oculoplastic Surgery society, the American Association for Pediatric Ophthalmology and Strabismus, the North American Neuro-ophthalmology Society, and the Canadian and American ophthalmology societies. He has written more than 60 clinical papers and given more than 100 lectures. His special interests include eyelid surgery, eyelid tumours, orbital surgery and tumours, Graves ophthalmopathy, eye muscle realignment surgery (strabismus), and Bells palsy.

Vishakha Thakrar

Vishakha Thakrar BSc, OD, FAAO, is an Optometrist and Contact Lens Fellow, Vaughan Family Vision Care. Dr. Thakrar has worked in optometry clinics in both Canada and the United States. She held the role of Director of Contact Lens Service at the Cole Eye Institute, Cleveland Clinic Foundation. She also participated in research activities in collaboration with the Department of Ophthalmology. In recent years, Dr. Thakrar has served as a contributing editor for the journals Contact Lens Spectrum and Eye Care Review and has written many articles on various optometric topics. She also speaks in the United States and Canada on contact lenses and eye diseases. Dr. Thakrar has received contact lens awards from Johnson and Johnson Vision Care, CIBA Vision, the GP Lens Institute and the College of Optometrists in Vision Development.

Anastasia Faggioni

Anastasia Faggioni, BScN, is a Medical Student at Northern Ontario School of Medicine and participates as a Local Exchange Officer on the school’s Global Health Committee.

facial paralysis

Redefining a Smile: John’s Marathon Journey Towards Reanimation

joanne — Sun, 28 Apr 2019 21:38:52 +0000

Redefining a Smile: John’s Marathon Journey Towards Reanimation joanne Sun, 04/28/2019 - 17:38

John Gerritsen shares his experience for treatment of a large Acoustic Neuroma followed by facial reanimation surgery.

John Gerritsen

My journey began in May 2017 with a call from my doctor’s office saying my MRI results were in. As I was enjoying an amazing family vacation in a Florida theme park, I waited until my return to see the doctor and enjoyed the rest of my vacation.

The MRI revealed a large Acoustic Neuroma (AN). I had been to see an ENT specialist years earlier for a hearing assessment. As it turns out, the explanation that my hearing loss was a result of occupational hazards proved to be wrong. I cursed my stupidity for not having insisted on further diagnostic testing. In the meantime, an AN had grown without any nasty symptoms. Now, with the MRI results, I began moving into a new phase.

Following the AN diagnosis, I learned to manage the pain from pressure in my head, and also my new unsteadiness while I waited for surgery. Daily Advil and elevators were my friends. Finally, on December 18, 2017, a tumour the size of a golf ball was removed during a 12-hour surgery at Toronto Western Hospital.

My mantra – you must always look forward and make the best of what you’ve got. Be patient, let your body heal and pursue opportunities to make it better...

The Good News

The surgery went well: the pain was gone and most of the tumor was gone. My brain stem that had been as tight as a drum was back to its old fluffy self with no apparent adverse effects. After a few days, I was up walking with a walker, and I was home before Christmas.

New Challenges

I had some temporary nerve damage that froze the left side of my face and caused me to speak in a whisper. Once again, I adapted: straws and soft foods were my new friends, and I wore a patch to protect my eye in extreme cold. My patient wife became expert at adding gel to my eye, helping the new me with daily tasks, and buying time for my body to heal . . . and it did! Gradually, I gave up the straws and my voice got stronger. With physiotherapy and exercise my balance improved. After three months I was ready to battle the crowds in downtown Toronto to commute to work again.

But ... my face was still not normal. I could not smile or completely close my left eye. Regular application of gel or drops protected my eye from damage but kept it blurry. Care was needed to keep my mouth clean.

By August 2018, it became apparent that my face would not fully recover. The area around my left cheek was still frozen, with my eyebrow sliding towards my eye.

Opportunity and Help Comes My Way

Opportunity appeared in the form of Dr. Baltzer, a skilled plastic surgeon who years earlier was a resident at SickKids working with Dr. Zuker. Dr. Zuker is a pioneer of “smile surgery”, who had honed his skills over decades of helping kids around the world. Dr. Baltzer, now with the University Health Network and Toronto Western Hospital, works with Dr. Zuker to offer this expertise to adults with facial palsy.

When I first met Dr. Baltzer and Dr. Zuker in September 2018, I was caught a little off-guard, having anticipated more traditional plastic surgery options. Instead, I was presented with a facial reanimation surgery option, whereby a nerve graft is used to restore natural facial movement! It was a unique and unexpected opportunity, but I had to decide quickly as the unused muscles in my face would soon start to atrophy.

Honestly, I was a little gun shy. I had just started feeling strong again and more like my old self after the last surgery. Did I really want more surgery? Dr. Baltzer was patient with me. She gave me time to consider the option while filling out the needed forms in case I decided to go ahead. I asked her if she would be doing the surgery herself. Her answer was, “Definitely!”

A quick Google search showed that facial nerve grafts were being used at top medical centres with some amazing results. Of course, there are no guarantees -- life is full of risks – but the surgery appeared to offer the potential for excellent results, with little downside risks beyond that of normal surgery. One cost: a sensory nerve would be taken from my leg, and I would be left with numbness around my heel.

On November 26, 2018, I underwent facial reanimation surgery. Although it was a five-hour delicate surgery, I recovered quickly. Dr. Baltzer and Dr. Zuker removed a sensory nerve from my left leg and weaved it from the moving side of my face to the paralyzed side, across my upper lip and across my eyebrow. They also lifted my left eyebrow to give my eye a normal shape. The surgery went well, and I was back to work after a two-week recovery period. My face and leg were still tender, so I avoided any pressure on my face and any heavy lifting.

The Journey is a Marathon Not a Sprint

It is now three months later. The surgical team had done an excellent job. The most immediate improvement was the brow lift, with the left brow now aligning perfectly with the right. More important still, my eye resumed a more normal shape, which helped it to close. The facial incisions along my ears, eye brow and the inside my mouth healed quickly, while the brow lift incision was deeper and took a little longer to heal. Facial scars are now either non-existent or invisible to the casual observer.

My leg works great. I can move normally, walk and run. A small area on the left side of my left foot around my heel is numb, feeling something like when your arm goes to “sleep” from a lack of circulation. I notice it sometimes, but I’m used to it.

Is there new facial movement? Nerves can take a frustratingly long time to heal and the grafted nerve needs to grow in. My wife and I have noticed slight improvements to the definition of my face and there is some new movement. We won’t know the full story for another six months or so. Next is facial physiotherapy and exercise in front of a mirror to help wake up sleeping muscles and teach them to work in concert with the right side of my face again.

More good news, my recent MRI showed my brain is stable with no change to the small remnant of tumor by my left ear. My wife teases me that she wants it in writing that I’m mentally stable!!

My journey is a marathon not a sprint. I’m feeling good and I’m optimistic for the future. As I plan another family vacation to Florida, I ask myself if I would agree to facial reanimation surgery again? Was it worth it? Definitely!

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Complete Facial Palsy: 4 Things You Can Do

admin — Mon, 19 Sep 2016 15:34:09 +0000

Complete Facial Palsy: 4 Things You Can Do admin Mon, 09/19/2016 - 11:34

Susan Rankin, BScPT, MHSc is a physiotherapist practising in North Vancouver, BC at Canopy Integrated Health. She was trained in 1986 by a therapist from Madison, Wisconsin where facial neuromuscular retraining began.

When I first started treating acoustic neuroma (i.e. vestibular schwannoma) patients 30 years ago, about 50% of my clients had facial palsy as a result of microsurgery to remove an acoustic neuroma. Thanks to much better facial nerve monitoring during surgery, and other options like stereotactic radiosurgery or monitoring, I see only the occasional acoustic neuroma patient in my private practice now.

The few people I’ve seen recently have all reported similar outcomes postoperatively. The acoustic neuroma was successfully removed, the facial nerve was preserved and was working initially. Then, within the first few days, the affected side of the face suddenly falls.

The convention for most facial therapists is to wait until the patient starts to get movement before they begin treatment. However, I have always preferred to see people once early on. When people are sent home and told to wait for recovery, they often don’t know what to do while waiting. It’s not unusual that they then check out "Dr Google", surely it will have some advice on what to do. As we all know there’s good information and not so good information on the internet. I’d rather give people good information about what to do and what not to do in those early days.

There are four things I review with people when I see them initially.

1. EDUCATION

Using pictures, I review the facial nerve structure and function, degrees of injury to the nerve, recovery profiles and some general timelines for what to expect. I emphasise that no gross facial exercises should be done until the nerve and the muscles are "plugged in" on the affected side -- regardless of what the internet or friends and family say. Exercising before the nerve has recovered and reconnected with the muscle will only strengthen the good side and cause more dissymmetry.

2. EYE CARE

When the eye can't close, and tear-duct function has been affected, the eye is at risk. Patients can develop dry spots on the cornea or experience corneal damage. I usually recommend people see an Ophthalmologist who will examine the cornea and decide if protective surgery is required. Eye products should be preservative free and used frequently, not just when the eye feels dry; that's too late. Heavier ointments like Lacri-Lube and Tear-Gel can be used at night. I also review the use of eye taping, protective sunglasses and manual blinking.

3. IMPROVING CIRCULATION

Because muscles are not in use, blood circulation tends to be poor. As a result, it is important to maintain good circulation on the affected side. It can be done by applying moist heat for 5 minutes, 3 to 5 times a day or by tapping the face for 20 seconds, frequently during the day.

4. MAINTAINING SYMMETRY

While one side is doing all the talking and making facial expressions, it becomes stronger and pulls the face to the unaffected side. The mouth and the nose are particularly prone to pulling over. A simple technique is to passively pull the mouth and nose on the strong side back towards the middle. It is called a half-circle massage, and it is best done after laughing or talking a lot. I review these four things with people who have no facial recovery after acoustic neuroma removal. Once they have that information we stay in touch to see how they recover and decide if any further therapy is required.