This young man presented following resection of a left intracranial vascular tumor, resulting in left-sided dense facial paralysis. Okay, Jarrett, now look at me. Just smile with your mouth closed. Okay, you call that a smile? One more. Okay, now open your mouth. Smile, big smile with your teeth. Smell those teeth, Jarrett, come on. Yeah, good, good, okay. A 23-year-old young man who suffered from an intracranial vascular hemangioma at age 17. I had a hypoglossal to facial nerve anastomosis to restore his natural facial muscles seven months later, followed by a free gracilis to a cross-faced nerve graft at age 19 to give him spontaneity of smile. We're going to demonstrate his smiling. Jarrett, go ahead and tell me your name and what you're doing right now. Hi, I'm Jarrett. I'm 23. I'm currently in school as a physical therapist assistant, and I'll be done in one more year. Great. Jarrett, I'm going to ask you to close your mouth and just smile naturally, a nice, good smile. And now strengthen it with your tongue while you're still closing mouth. Now go ahead. There you go. So once again, mouth closed, just smile without your tongue. Now with your tongue. Thank you. Now let's do the same thing with your mouth open. Mouth open. Smile. Now use your tongue. Great job. Relax. Now I'm going to ask you to close your eyes slightly. Now move your tongue at that level. Move your tongue back and forth. Very nice. Thank you. This seven-year follow-up demonstrates that the young man has achieved spontaneity of smile with the cross-faced nerve graft to free gracilis on the left side. He is also able to use the 7 to 12 anastomosis to strengthen that smile as demonstrated when he moves his tongue. It also helps with eyelid closure, but he has had some corticoplasticity and does not get excess synkinesis when he moves his tongue. Thank you.

facial paralysis

nerve graft

intracranial tumor

smile restoration

physical therapist