Woman Gets Her Smile Back after Losing It for Four Years

The new year is a time for reflection. For Karen Kmoch, 2024 is the year she got her smile back.

“At times I felt broken,” Kmoch said. “I felt that if I breathed my last breath, I was ready to go.”

Seventy-year-old Kmoch’s journey began in November 2019 when she noticed her cheek was swollen. Concerned, she visited her dermatologist, who urged her to see her primary-care doctor immediately. What followed was a whirlwind of appointments, tests, and, eventually, a life-altering diagnosis. Kmoch had high-grade basaloid carcinoma with squamous differentiation, a rare and aggressive form of cancer.

Kmoch’s primary-care doctor referred her to the emergency department, where tests revealed the severity of her condition. She was referred to Paul Walker, a head-and-neck oncologic surgeon at Loma Linda University Health.

In early 2020 Kmoch underwent her first surgery, believing the cancer was in its early stages. However, the surgical team discovered it was more advanced than anticipated. The stage 4 cancer had tangled itself around her facial nerve, leading Walker to try to remove the tumor without damaging it. The complexity of the cancer required Walker to cut through the nerve and remove 46 lymph nodes. Kmoch endured an intense treatment regimen: five days of radiation therapy for six weeks and one day of chemotherapy each week during the same period.

Subsequent surgeries were necessary to reconstruct her face and restore its functionality. Kmoch underwent a facial sling procedure and later worked with Jennifer Fuller, a facial plastic and reconstructive surgery specialist, on a cross-facial nerve graft.

Fuller performed a two-part surgical procedure to restore Kmoch’s ability to smile and improve facial symmetry. The surgery involved connecting a nerve from the functional side of her face to the paralyzed side using a long nerve harvested from her leg. “This new nerve would allow the functional side of her face to drive a smile on the nonfunctional side,” Fuller said. After six months of nerve growth, Fuller performed a second intricate 13-hour surgery transplanting a muscle, the gracilis, from Kmoch’s leg to her face. The muscle was connected to the new nerve and a chewing nerve, allowing Kmoch to create a spontaneous, functional smile. Fuller also used additional tissue from Kmoch’s leg to improve facial symmetry and reposition features.

In addition to restoring her smile, Fuller addressed other functional issues caused by facial paralysis, such as difficulty closing her eye, which could lead to blindness. She inserted a small platinum chain into Kmoch’s eyelid, enabling proper closure.

The waiting period to see if the nerve would connect was emotionally taxing, but Kmoch remained hopeful. After her third surgery Kmoch noticed significant improvements.

“People take a smile for granted,” Kmoch said. “I’m a smiling person, and it was taken away from me for a while, but now that it’s back . . . You just don’t know how much it means to me.”

The journey was not without challenges. Kmoch found solace in the support of her sister Nancy, who accompanied her to every surgery, and her speech therapist, who became an emotional anchor. Kmoch also joined a head-and-neck cancer support group, where she connected with others facing similar struggles.

Kmoch’s faith and community played pivotal roles in her recovery. “When I was at my lowest, I could feel [God’s] arms wrapped around me, giving me peace,” she said. Staying active in her church and helping others brought her purpose and strength.

Though Kmoch’s journey is ongoing, with the potential for one more surgery to refine her smile, she remains optimistic. A recent PET scan showed a few areas of concern, but Kmoch approaches the future with humility and gratitude. “It really makes you humble,” she said. Both Kmoch’s parents had cancer, and she’s no stranger to its challenges. In her words: “This experience has changed me forever.”

For Kmoch, 2025 isn’t just about recovery; it’s about rediscovering the joy of living and sharing her smile with the world. 

The multidisciplinary approach used to treat Kmoch is an everyday practice at Loma Linda University Health.

The original version of this story was posted on the Loma Linda University news site.