Six-year-old Smiles For the Very First Time, After Nerve Transfer Surgery at St. Louis Children's Hospital

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Facial re-animation surgery fixed Dawson's facial paralysis, allowing him the ability to smile.

Dawson Barnett and Dr. Alison Snyder-Warwick

It’s the kind of procedure you want to have someone focused on because it’s very detail-oriented

Six-year-old Dawson will initiate an impromptu dance party, play a practical joke on his mom, or do whatever it takes to make his friends and family laugh. Now, for the first time, he’s laughing along with them after life-changing surgery to help him smile.

Born with a rare disease called Mobius Syndrome, which causes facial nerve paralysis, Dawson had never been able to create facial expressions.

“People look at him and think he’s angry,” explains his mom, Sarah Barnett. “When you spend time with him, you can tell the difference between crying and laughing, when he’s upset, just from his body language.”

Mobius Syndrome also caused webbing between Dawson’s fingers, and an inability to move his eyes laterally – from side to side.

“Dawson was five when we initially met and talked about several procedures we could do for him,” says Dr. Alison Snyder-Warwick, Washington University pediatric plastic surgeon at St. Louis Children’s Hospital. “He was interested in having better hand movement, and in his facial expression – getting his smile back.”

What resulted was a series of four surgical procedures over the next year; two to separate his fused fingers and improve mobility to his hands, and two muscle and nerve transfers to reconstruct smile on each side of his face.

To perform the facial surgery, Dr. Snyder-Warwick borrowed a piece of muscle from Dawson’s leg, called the gracilis muscle, and transplanted it- along with its own nerve and blood supply – into Dawson’s face. She then identified a nerve in Dawson’s face that does function – for Dawson, it was the masseteric nerve, commonly used in chewing – and attached it to the transplanted leg nerve.

“We orient the leg muscle from the corner of the mouth to up near the temple,” explains Snyder-Warwick. “That way when the muscle contracts and shortens, it pulls the corner of the mouth up to make a smiling movement.”

Results from a nerve transfer typically take four to six months, giving the nerves time to take root in the muscle. Dawson’s case was unique.

“About a month and half afterwards, he was already moving it. That was very shocking to us – and exciting,” says Barnett.

Three months later, it was time to make Dawson’s smile symmetrical and perform a muscle and nerve transplant on the other side of Dawson’s face.

“It was probably a month and a half, two months before he started having movement on that side, too - just in time for picture day in school,” says Barnett. “I was tearful. I didn’t expect it to happen so quickly again!”

The results are easy to visualize, as they’re on display from ear to ear on Dawson’s face.

The Facial Nerve Institute at St. Louis Children’s Hospital and Washington University School of Medicine is one of only a small handful of pediatric centers in the nation that focuses on this specialized form of facial animation surgery. It’s Dr. Snyder-Warwick’s clinical specialty.

Smiling is so important to who we are and how we perceive ourselves and relate to other people,” she says. “It’s very rewarding to try and give people that confidence that they can go do all the great things that they are meant to do in life.

“It’s the kind of procedure you want to have someone that’s focused on it because it’s very detail-oriented,” she adds.

Dawson now has the ability to smile, but he needs to train himself to do it. Since the muscle is attached to the nerve that controls chewing, he must bite down in order to produce a smile. It requires conscious effort, but will become more natural.

“Both kids and adults have shown us after having this procedure they can get a smile back without having to think about smiling,” says Snyder-Warwick.

Dawson can practice making the smile motion while he looks in the mirror – something he enjoys doing now.

“Dawson is a very dynamic little guy,” says Snyder-Warwick. “He is engaging, he is funny, he is entertaining.”

Now, for the first time, you can see it on his face.

“He is funny, loves to make people laugh, loves to laugh. He just wants to be part of the crowd,” says Barnett. “I absolutely love his smile. It brings a smile to my face every time I see him use it.”

Click here to watch Dawson's story.

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Jackie Ferman
since: 01/2009
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St. Louis Children's Hospital
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