Tips and Pearls for Recovering Symmetry After Facial Palsy Using a Tendon Sling: Our 20-Year Experience

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Facial Nerve Surgery

Background:

• Static slings offer an alternative for facial palsy reconstruction, suitable for patients unsuitable for complex procedures or as an adjunct to dynamic reconstruction.
• Facial palsy significantly impacts appearance and function, necessitating effective reconstructive solutions.

Purpose of the Study:

• To evaluate the efficacy of plantaris tendon slings in improving facial symmetry and quality of life for older adults with flaccid facial palsy.
• To assess the long-term outcomes and reliability of static reconstruction techniques in facial paralysis.

Main Methods:

• A cohort of 46 patients undergoing static reconstruction with a plantaris tendon sling were retrospectively studied.
• Surgical techniques, including tips and pearls, were detailed.
• Facial symmetry was assessed using FACIAL CLIMA and Sunnybrook Facial Grading System; quality of life was measured by the Facial Disability Score.

Main Results:

• Significant improvement in oral commissure symmetry (97% recovery) and elevation (1.5 cm) at 2 years post-surgery.
• Improvement in symmetry at rest was noted (-15 points on Sunnybrook scale) at 2 years.
• Substantial gains in physical disability (+73.5%) and social impairment (+21%) were observed at 1 year.

Conclusions:

• Plantaris tendon slings provide a reliable static reconstruction method for facial paralysis.
• The technique demonstrates good long-term functional and aesthetic outcomes.
• No functional sequelae were reported, highlighting the safety of this reconstructive approach.