Hope that Boitumelo will soon be able to smile like other little girls

Boitumelo Moretsele would often stand in front of the mirror trying to “fix” her lopsided smile with her fingers.

The Grade 2 Brakpan North pupil could not understand why other children ridiculed her because she appeared different to them.

For most children at Boitumelo’s age pulling a funny face‚ smiling and frowning happen without a thought.

Not so for the seven-year-old‚ who was born with a complex congenital neurological disorder‚ Moebius Syndrome‚ which has robbed her of her ability to smile.

The disorder can affect multiple cranial nerves including the facial nerve‚ which results in paralysis of the muscles that bring about facial movements. The condition is so rare‚ that there are no statistics available in South Africa.

Now thanks to the Smile Foundation and a team of expert surgeons‚ Boitumelo may soon be able to express her happiness‚ joy and even sadness.

The little Gauteng girl was almost ten hours under the knife at the Inkosi Albert Luthuli Hospital in Durban this week.

She and eight-year-old Olwethu Diseko from Potchefstroom‚ who is also afflicted with paralysis on one side of her face‚ were operated on by a team of surgeons including the Smile Foundation’s medical director‚ Dr George Psaras‚ Professor Anil Madaree‚ who heads the University of KwaZulu-Natal’s department of plastic and reconstructive surgery‚ and Dr Mahendra Daya‚ the university’s principal specialist.

The microscopic reconstructive surgery was part of a first-ever Smile Facial Reanimation Week‚ in which the tertiary‚ paperless hospital and the Smile Foundation - an NGO that helps children with facial or other conditions receive reconstructive surgery - joined forces.

Due to its rarity‚ few surgeons are exposed to or have shown an interest in treating this condition.

Apart from performing the complex procedures‚ Psaras also conducted a skills exchange with both plastic surgeons and medical students.

Boitumelo’s parents Juliet‚ a pharmacist‚ and Happy‚ a pastor‚ said they were relieved their daughter was on the road to recovery.

“We are so grateful to the foundation and the doctors who have given our little girl the chance to smile again. When she first started school‚ she would come home crying.

“She would stand in front of the mirror and try to fix her smile with her fingers. She would cry because she couldn’t understand why children laughed at her.

“I was heartbroken. When a doctor referred me to the Smile Foundation two years ago‚ it gave us all hope.

“They can give other children like Boitumelo hope too. I really hope that other mothers don’t hide kids like this‚ there is help out there.

“I spent the nine hours and 45 minutes my child was in surgery praying. The team was wonderful‚ they even texted me from the theatre‚ to tell me the surgery was going well‚” said Juliet.

Psaras said the surgery would give both girls the chance to be normal again.

Explaining the complex procedure‚ he said: “What we did is transplant the muscle from the thigh to the face and make that muscle work.

“The principle of this whole thing is to take a muscle‚ what we call a free flap. In other words we detach the artery in the vein that goes into the muscle and nerve. We take the whole thing en bloc and transplant it into the face.

“We have to reconnect the artery in the vein or else it will die in six hours.” The surgeons have to ensure that there is blood flow and then attach the nerve to a viable one in the facial area.

“We find the branch of the masseteric nerve‚ the big one that we use to chew‚ and hook it onto that.

“That gives you the electricity that basically flows from the brain‚ goes into the nerve and then into the muscle we transplant and then it starts moves‚” said Psaras.

Psaras has conducted almost 60 of these surgeries in South Africa.

He believes the surgery would improve the girls’ speech and appearance.

“It’s very important with girls that age because they usually get ridiculed by their peers and are often perceived as unintelligent and they’re left behind. A kid who doesn’t show emotion and doesn’t smile‚ people lose interest. This will give them the ability to reintegrate into the group and become normal‚” Psaras added.

The children will be in hospital for a week.

“Their movement won’t happen for another six or seven weeks. They can’t chew for another three weeks.”

Daya said the hospital has not seen many cases of congenital facial paralysis.

“It is not surgery that is commonly done‚ it is not surgery that we would also commonly do‚ for one simple reason‚ is that we have other cases which is trauma and tumours‚ which predominates our time.

“This has given us a wonderful opportunity to learn from Dr Psaras‚ to show us the fine-tuning with regards to this operation‚ so that we can do it like he has been doing it for all these years.”