UNLV Physician’s Skills Include Craniofacial Surgery

Moebius syndrome — a rare congenital condition that can paralyze the entire face and affect muscles that control back-and-forth eye movement.

To unlock Moebius paralysis — it affects something we take for granted, the ability to smile — is something that Dr. John Menezes, an associate professor of plastic surgery with the UNLV School of Medicine, has been trained to do.

“To be able to change a child’s life, change a family’s life for the better, is rewarding, “says Menezes, the only fellowship trained ( Johns Hopkins University School of Medicine )craniofacial surgeon in Las Vegas. “I’ve always wanted to make a difference.”

In April 2017 readers of the Las Vegas Review-Journal learned that 8-year-old Abraham Chavez, who’s known as AB, was born with Moebius syndrome. While his condition was not full blown — his eyes were not affected — the paralysis he suffered made it impossible for him to smile. Readers also learned that Menezes spent nine hours performing a transplant that would give the little boy a chance to be like other children.

“I just want to be able to smile like other kids,” AB said prior to the procedure at University Medical Center .

What Menezes did was transplant the expendable, thin gracilis muscle and its associated nerve from AB’s thigh — several other muscles do its same function — to AB’s cheek, to help him smile.

It is painstaking surgery. The nerves and blood vessels involved are no more than 2 millimeters in size. Stitches are finer than a human hair. Dissection of the tissues and connection of the artery, vein and nerve takes six to eight hours.

At first, Menezes created a face-lift kind of incision in front of AB’s ear and extended it below the angle of his jaw. Then, much like a face-lift, the skin and fat were lifted from the cheek, creating a pocket to accept the muscle transplant.

According to Menezes, biting down is initially required to produce a smile, but later a child can adapt and learn to smile in an almost spontaneous manner.

Today, AB can smile. That makes AB’s mother and Menezes smile.

“We need to continue to turn lives around,” says the physician who regularly deals with cleft lip and palate repair, ear reconstruction, microsurgery, adult and pediatric facial trauma and the correction of skull birth defects. “Teaching medical students and residents in this field is most important. Keep in mind cleft and palate happens in one in a thousand births. So if there are 40,000 new babies born a year in Nevada, there are 40 infants who need cleft surgery each year. That’s just for the primary reconstruction, and then there are secondary surgeries in early childhood and final reconstructions in the teenage years…”

Menezes, who also does elective plastic surgery, is about to once again embark on a pediatric plastic surgery path that took him to the Philippines to repair cleft palates.

“I want to take medical students with me,” he says. “I stopped for a few years while I was growing my own family (he now has two children of his own) , but now it’s about time to start that work again.”