What is sling operation for facial palsy?

When surgeons treat patients with facial palsy they perform operations that improve the symmetry of the face at rest (static procedures) or those that improve the symmetry both at rest and when moving the healthy side of the face (dynamic procedures).

Sling operation for facial palsy is a static procedure as it aims to improve the symmetry of the mouth when the patient’s face is at rest. The fascia latais a tough sheet of tissue that can be found just underneath the skin in the thigh.

Who is a suitable candidate for sling operation for facial palsy?

It may seem strange to offer an operation that only improves the symmetry of the face when a person is not smiling (static procedures). However, given the complexity of dynamic procedures and the length of surgery required to perform these operations, not all patients are suitable for dynamic procedures that will improve the symmetry of their face both at rest and when smiling.

Static procedures, like the fascia lata sling, are ideal if anyone wants a quick solution to reduce problems such as significant facial asymmetry and drooling of the mouth.

What are the risks of sling operation for facial palsy?

In general, the risks of any operation relate both to the anesthetic and to the operation itself. The operation is performed under general anesthetic, which means that the patient is asleep throughout. The anesthetist will go through the risks relating to the general anesthetic with the patient before the operation.

Bleeding and hematoma: If bleeding occurs after sling operation for facial palsy, it creates a collection of blood underneath the skin called a hematoma. If this occurs, the patient will notice worsening swelling and bruising around the cheek and should seek urgent medical attention. This may require another operation to remove the collection of blood. This is a rare complication.

Infection: All operations are at risk of causing an infection. This can occur in around 2-5% of these operations. The patient should look out for increasing pain, redness and fluid discharge from the wound and fevers as a sign that he may have a wound infection. This will require antibiotics and possibly re-admission to hospital.

Asymmetry: The side of the face that has been operated on will never be perfectly symmetrical with the other side. It is also important to remember that the patient still won’t have movement on the side of the face that has been operated upon and that the asymmetry will be worse when he smiles. Furthermore, this operation only aims to address the asymmetry of the mouth and won’t change the symmetry of the eyes or forehead.

Sling dehiscence: This means that the sling pulls off from the areas that it has been attached to. This can be either the lips or the cheekbone. The surgeon will take extra care to try and minimize the risk of this happening, but if it does occur the patient may require another operation to correct the position of the fascia lata sling.

Are there any alternatives to sling operation for facial palsy?

This is not a life-saving procedure and, therefore, the main alternative is to have no surgery at all. If the patient has decided that he would like surgery to improve his appearance and the function of his face, other alternatives do exist.

Broadly speaking these can split into those that improve the symmetry of the patient’s face at rest but do not produce any movement (static procedures) and those that improve the position at rest and can produce movement of the face to express emotions (dynamic procedures). Sling operation for a facial palsy procedure is a static procedure.

The main advantages of static procedures are the shorter length of surgery and hospital stay, the ability to perform the surgery in one operation and the reduced risk of failure. Dynamic procedures are longer, more complex and come with more risks.

How can anyone prepare for sling operation for facial palsy?

The patient will need to take time off work for the surgery. To begin with, the patient will be in hospital overnight. After this, the doctor would recommend that the patient take a further two weeks off work to recover.

Any sports should be avoided for 4-6 weeks and the patient should try to stop or cut down any smoking in the lead up to the operation and for the six weeks following surgery. Smoking will increase the risk of the muscle not working and the wound not healing.

What does sling operation for facial palsy involve?

Sling operation for facial palsy is done under general anesthetic, so the patient will be asleep throughout the procedure.

The fascia lata is just underneath the skin of the thigh. A section can be removed between two separate cuts made in the thigh.

The surgeon will then make a cut in front of the ear and make a pocket underneath the skin of the cheek through which the fascia lata sling can be passed. In addition to this cut, further cuts are made on either the outside or inside of the upper and lower lips so that the surgeon can ensure that the fascia lata sling is stitched into the correct position to give the patient the best possible outcome.

The surgeon will then stitch the fascia lata into the correct positions around the mouth and will then carefully adjust the tension to give the patient’s mouth the best possible symmetry. The outer end of the fascia lata sling is then stitched to the patient cheekbone to anchor the sling in place and reduce the likelihood of it moving.

Finally, the cuts are stitched up and a large bulky head bandage will be placed on the patient’s face to minimize any swelling after the surgery.