In October 2015, Phuong Nguyen, a plastic and reconstructive surgeon at the Children’s Hospital of Philadelphia (CHoP) for 10-year old facial tumor patient Kevin Portillo’s cranked up some rock music in the operating room (he plays in a band), and began by removing a section of nerve from Kevin’s right ankle and attaching it to the working right side of his face, running it underneath his upper lip, to the paralyzed left side.
The nerve’s growth took almost a year: the fibers advanced about a millimeter a day (24,000 times slower than a snail). During that time, doctors would periodically tap areas of Kevin’s cheek to see if the nerve was taking. “When it tingles, you know the nerve is growing,” says Dr. Nguyen. Once he was certain the nerve was in place and functioning, it was time for the second stage of the surgery.
He wrote a “P” on Kevin’s left temple and an “NP” on his right, for “paralyzed” and “not paralyzed.” He also drew an arrow: the vector Kevin’s smile would take. Dr. Nguyen then removed muscle, nerve and an artery from inside of Kevin’s left thigh, securing them with a customized splint that hooked into Kevin’s mouth and the side of his head.
Kevin began sessions with Anne-Ashley Field, his occupational therapist at CHoP. She had him hold a two-cent white plastic fork in his mouth and show he could move it up and down.”Try to purse your lips together to make it stand up. We’ve got it pretty solid in the middle — try to work it over to the weaker side.”
Next Kevin puts on latex gloves and pulls at the inside of his cheek. “You’re going to do your stretch on the inside,” says Field. “A nice, slow hold. Good. Bring that thumb up…do you feel like it’s getting looser than it was?”
They move on to a Lenovo biometric therapy system. Field sticks an oblong black sensor that reads electrical activity in the muscle — to Kevin’s left cheek, and he plays a video game where he moves animated boxes from a conveyor on the screen by smiling and relaxing. “Give me a big smile,” Field says, calibrating the device. “And relax.”
How does Kevin feel about being able to fully smile after a lifetime of not being able to? “Before, I was actually shy,” he says. “Right now, I’m less shy, more active. I’ve been getting better on how I react — I do it automatically. When somebody says a joke, and I laughed before, I laughed weird, and it felt weird to not smile.
“Smiling with both sides of my mouth at same time, I feel I’m one of the other people who smiles right. Now people know if I’m smiling or laughing. When I play soccer, and score a goal, I’m happy. I’m smiling, to tell everybody I scored.”