Mary is a three-year-old who had a parotid cyst from birth until October 2015, when we did her surgery. Her father is a waiter in a hotel, and her 19-year-old mother is finishing secondary school, so they could not afford the surgery elsewhere. Mary traveled an hour by a public bus with her aunt and grandmother to get her surgery at Tawfiq Hospital in Malindi, Kenya.
The set of nerves that make you salivate when you see or smell food (called the parasympathetic nerves) are covered by the parotid, which we removed in order to remove all of the cysts, carefully tracing and saving the facial nerves that run through that area. Most doctors just lay skin back over the surgical wound, including doctors in Kenya, but we replaced the removed flesh with a free fat transfer, which was composed of fat from under the skin in her lower belly. Without the free fat transfer, the parasympathetic nerves would invade the sweat glands, and whenever she smelled food she would sweat profusely from the area of the surgery. This gustatory sweating, or Frey's Syndrome, is embarrassing and uncomfortable.
Aside from preventing gustatory sweating, our doctors wanted to retain her facial nerves, which determine her facial expressions. A facial nerve paralysis is often not noticeable when the face is at rest, but when a person with a facial nerve paralysis smiles, only one side of their face moves. Consequently, the happier they are, the more asymmetrical their face.
Our doctors, in cooperation with the Kenyan doctor-trainees, were able to save both her upper division facial nerves (which control the movement of the eyes and forehead) and the lower (which control the mouth and chin). Her upper division nerves function normally already. Her lower division nerves are weak, but should make a full recovery over time.