A Dream Delayed : Fever Blister Forces Postponement of Operation to Give Palmdale Girl a Smile

As 7-year-old Chelsey Thomas waited for nurses to wheel her into the operating room, she drew a quick sketch of herself holding hands with her friend Ryan. On each face she penciled in a grin.

The picture represented what the platinum-blond second-grader from Palmdale has longed for all her life: the ability to smile.

Tuesday morning at Kaiser Permanente’s Woodland Hills Medical Center, her dream was on the verge of coming true.

Born with an unusual medical condition known as Moebius syndrome, which causes partial facial paralysis, Chelsey was poised to undergo a seldom-performed surgical procedure that could have paved the way for her first smile.

But at the last minute, with Chelsey already sedated and Dr. Ronald Zuker, a microvascular surgeon from Canada, preparing to operate, doctors noticed a single fever blister on the left side of the girl’s lip.

The surgeons hesitated. Ordinarily insignificant, the blister posed an immediate and serious threat to the success of the surgery. After consultation with other specialists, the operation was postponed.

With Chelsey still sedated, doctors broke the news to her parents and then told a crowd of reporters and television crews who since last spring have covered the story of the little girl’s quest to smile.

“The parents took it very well,” said Dr. Joseph E. Ruderman, area medical director at Kaiser. “The one who will be most disappointed, I’m afraid, is the youngster.”

Before being sedated, Chelsey had given doctors a deadline: She wanted to smile before her 8th birthday in June. With surgery now tentatively rescheduled for January, doctors said they may still make the deadline.

Chelsey’s mother tried hard over the last few weeks to prevent her daughter from becoming ill--no small feat with three brothers and children from a day-care business in and out of the house.

Chelsey was in good spirits Monday. When asked to whom she would show her first smile, she said: “Me. I’m going to smile at me.”

The surgery, performed on one side of the face at a time, involves transplanting part of the thigh muscle into one cheek, then attaching blood vessels and a functional nerve to the new muscle. The delicate operation is performed almost entirely under microscopes using needles thinner than a strand of human hair. After healing, which can take several months, the surgery is repeated on the other side of the face.

Doctors said that if the nerve attached to the transplanted muscle is diseased--say, by the virus that caused the cold sore--the chances of the muscle functioning properly would be reduced.

When her daughter awoke Tuesday, Thomas said, she told her the simple truth about the delay.

“It didn’t sink in right away,” Thomas said. “She thought she had the surgery. She knows, now. And she’s doing OK.”

Zuker, who has performed the delicate microsurgery on more than a dozen children afflicted by Moebius syndrome, said he had no qualms about returning to Woodland Hills to attempt another surgery in the next few months.

“Chelsey is a very important patient,” Zuker said. “She’s had a tough time and she’s been very much looking forward to this operation. It makes a huge difference to the self-esteem of these children, simply to be able to smile.”