Richard Lee Norris, 37, who lost most of his face in a gun accident in 1997, and underwent the most extensive full face transplant ever seven months ago, is “exceeding all expectations”, his doctors announced this week.
Richard Lee Norris had suffered a horrific gun accident in 1997 which claimed his lips, part of his jaw, and his nose. After literally having his face blown off, he managed his life as best he could for 15 years, wearing a mask and living as a recluse until he was selected for surgery.
In March 2012, at the R. Adams Cowley Shock Trauma at the University of Maryland Medical Center, a medical team completed a 36-hour surgical procedure in which they replaced Norris’ entire face, including his tongue, both jaws, teeth and nose. At the time, it was the most comprehensive face transplant on record; the hospital claims it still is.
Transplant team leader was Eduardo D. Rodriguez, M.D., D.D.S., associate professor of surgery at the University of Maryland School of Medicine and chief of plastic, reconstructive and maxillofacial surgery.
Dr. Rodriquez said in March that they used state-of-the-art surgical practices and computerized techniques to transplant the mid-face, maxilla and mandible including teeth, and a portion of the tongue with precision. they also transplanted all facial soft tissue from the scalp to the neck; this included the underlying muscle so that his face could move as he expressed himself, with all the sensory and motor nerves eventually restored with full feeling and function.
In March 2012, Dr. Rodriguez said:
“Our goal is to restore function as well as have aesthetically pleasing results.”
A few days after his surgery was completed, Norris worked with speech therapists, physical therapists and occupational therapists. Then started his long road towards re-gaining functional use of his jaw, tongue and new face.
The donor of the face remains anonymous. We do know that not only was his face used for transplantation, but other organs too.
The University of Maryland has released the most amazing pictures which show what Norris used to look like before his accident, then with the devastating disfigurement after, and two more photographs showing him within a week of the operation and how he looks today. They take the reader through a mixture of sensations, from shock and horror to amazement and joy. Norris really does have a face today which, as he said “No longer gets the stares and comments”.
2) After the gun accident.
3) One week after surgery.
4) His face today, 7 months later
Norris said yesterday (Thursday, October 18th, 2012):
“For the past 15 years I lived as a recluse hiding behind a surgical mask and doing most of my shopping at night when less people were around, I can now go out and not get the stares and have to hear comments that people would make. People used to stare at me because of my disfigurement. Now they can stare at me in amazement and in the transformation I have taken.
I am now able to walk past people and no one even gives me a second look. My friends have moved on with their lives, starting families and careers. I can now start working on the new life given back to me.”
“I am doing well. I spend a lot of my time fishing and working on my golf game. I am also enjoying time with my family and friends. I do still have follow-up appointments with a lot of different doctors and therapists to ensure everything is healing up properly. I have been undergoing physical therapy and also speech therapy. I have been doing very well regaining my speech back. Each day it improves a little more.”
His facial muscles are now starting to respond; today Norris smiles and is able to show facial expressions. According to the medical team, motor function is at about 80% on the right side of his face and 40% on the other side. Unlike before, he can now smell, taste, and eats mainly by mouth.
Norris’ rehabilitation team continues working with him to train his facial nerves to communicate with each other to restore normal movement and speech.
Rejection of transplanted tissue is something doctors need to prepare for and monitor continuously. Norris has been undergoing a complex immunosuppression regimen, which is overseen by Dr. Rolf Barth, associate professor of surgery at the University of Maryland School of Medicine and director of liver transplantation and hepatobiliary surgery at University of Maryland Medical Center.
Dr. Barth, who is also a research scientist, says it is crucial to reduce any chances of rejection and to minimize the side effects that may be caused by long-term usage of immunosuppressive medications. Doctors and patient have to walk a fine line between of making sure rejection does not occur, while at the same time keeping side effects to a minimum.
Stephen T. Bartlett, M.D., Peter Angelos Distinguished Professor and chair of the Department of Surgery at the University of Maryland School of Medicine, and surgeon-in-chief and senior vice president at the University of Maryland Medical System, said:
“We began this research more than 10 years ago when we saw the devastating injuries sustained by soldiers in Iraq and Afghanistan from improvised explosive devices. Now having seen how this surgery has changed Richard’s life, we are even more dedicated to researching ways to improve facial transplantation and helping more patients, including military veterans, return to normal lives after undergoing this same surgery.”
The University of Maryland facial transplantation program is being expanded to serve more patients, including military servicemen and women and veterans who were wounded while on active duty.
Norris’ face transplant occurred thanks to 10 years of R&D which was funded by the Office of Naval Research in the Department of Defense. Dr. Bartlett received a grant to research composite vascularized allografts for military personnel with facial injuries caused by improved explosive devices.
E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine, said “The results we’re seeing in Mr. Norris today are a reflection of the collaboration between our research and clinical teams who have worked tirelessly to give him a return to normalcy.”
“Thanks to all the people and organizations that made this possible: the grant from the Department of Defense’s Office of Naval Research; The R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center; Dr. Eduardo Rodriguez, his team and staff; Angel Flight Mid Atlantic; The Living Legacy Foundation of Maryland; and the family of the donor whose organs also saved the lives of five other people.”
Charla Nash, a 57-year old woman, underwent a full face transplant at Brigham and Women’s Hospital, Mass. in June 2011. She had been mauled by an angry 200-pound pet chimpanzee in February 2009. The attack left her blind. On the day of her operation she was quoted as saying that she would love to be able to eat pizza and hamburgers again, instead of the pureed food she had had to live on during the months preceding the operation.
A team of 30 people were involved in the procedure, replacing blood vessels, underlying muscles, teeth, the hard palate, and nerves.
First ever full face transplant – in April 2010, the first full face transplant was carried out at Vall d’Hebron University Hospital, Barcelona, Spain, on a man who had severely injured himself in a shooting accident five years previously. The accident left him unable to swallow or breathe.
A team of 30 doctors operated on the patients for over 20 hours to transplant a completely new face from the donor to the recipient, a farmer.
The patient received new muscles, jaw, cheekbones, nose lips, teeth, eyelids and facial skin. At the time, ten partial face transplants had been performed in various parts of the world – this was the first transplantation of a whole face, the hospital claimed.
Connie Culp, 46, a US citizen and mother of two, was involved in a near-total face transplant, according to The Lancet in July 2009. The patient had been injured after being shot in the face with a shotgun by her husband. She was left with most of the middle part of her face missing – she lost her nose, skin, vital nerves, mouth, and other structures. Before the operation she was unable to drink from a cup and her speech was slurred; she had no sense of smell.
Culp underwent 23 major reconstructive operations. However, the disfigurement remained , leaving her feeling humiliated every time she went out. Her doctors determined that the only way to effectively treat the disfigurement would be with a face transplant.
Isabelle Dinoire underwent a partial face transplant in 2005 at the Hospitalier Universitaire, Amiens, France. She had lost parts of her face when her dog tried to revive her during a suicide attempt.
A year later she described how wonderful it was to be able to go out without people staring at her. On two occasions her body started rejecting the foreign tissue, however, this was resolved with some adjustments to her immunosuppressant medications.
Li Guoxing, 30, received a partial face transplant in 2006 at the Xijing Military Hospital, Xian, China. The man’s face had been disfigured after a bear attack. Guoxing received a new upper lip, cheek and bone.
Written by Christian Nordqvist