Long‐term outcome of selective neurectomy for refractory periocular synkinesis

Veen, Martinus M. van; Dusseldorp, Joseph R.; Hadlock, Tessa A.

doi:10.1002/lary.27225

Cited by 35 publications

(39 citation statements)

References 20 publications

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“…Although chemodenervation with botulinum toxin has been a major treatment for postparetic synkinesis, other treatments such as neurectomy 2,3) and nerve transfer 7,8) are generating renewed interest in specialists. This is because both physicians and patients generally seek definitive and permanent solutions without repetitive procedures.…”

Section: Discussionmentioning

confidence: 99%

“…This is because both physicians and patients generally seek definitive and permanent solutions without repetitive procedures. However, selective neurectomy still requires postoperative chemodenervation in most cases [2][3][4] . Furthermore, some functional morbidity is reported after aggressive selective neurectomy 3,4) .…”

Section: Discussionmentioning

confidence: 99%

“…Among various types of synkinesis, oral-ocular synkinesis, which is defined as coordinated eye closure when eating, smiling, and speaking, is a devastating symptom and decreases the quality of life 1) . Botulinum toxin injections combined with facial neuromuscular retraining is a standard noninvasive treatment 2) . Conversely, selective neurectomy has recently been shown to be effective as a surgical treatment for facial synkinesis 3,4) .…”

Section: Introductionmentioning

confidence: 99%

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Selective Orbicularis Neuromyectomy: A Reliable Treatment for Periocular Synkinesis

Yoshioka

Yamanaka

Morimoto

2023

JPRS

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Objectives: Selective orbicularis neuromyectomy for postparetic periocular synkinesis was first reported in 2015. This study aims to statistically evaluate the accumulated outcomes and stability of this treatment. Methods: Twenty-five patients with postparetic periocular synkinesis were treated with this procedure between March 2010 and February 2020. Every patient was evaluated using the Sunnybrook scale, and their palpebral fissure width was measured using preoperative and postoperative videos. Patients who underwent >1-year follow-up were included in the study. Chemodenervation or physical therapy was not performed during the follow-up periods. Results: Of the 25 patients, 20 were included in this study. The follow-up period was 13-96 months (median 32 months). The mean of the patients' synkinesis scores fell by 4.6 points. Palpebral fissure width while puckering and at rest was significantly different between the preoperative and postoperative measurements (p < 0.01). Lower lid drooping gradually deteriorated in one patient 7 years after the treatment and was corrected secondarily. Conclusions: This study demonstrates that selective orbicularis neuromyectomy is a simple and sustainable treatment for periocular synkinesis. However, further longer follow-up of elderly patients and objective analysis are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Selective Orbicularis Neuromyectomy: A Reliable Treatment for Periocular Synkinesis

Yoshioka

Yamanaka

Morimoto

2023

JPRS

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“…4 Neurolysis has been utilized in patients with periocular synkinesis refractory to chemodenervation secondary to the formation of neutralizing antibodies. 62,63 A recent study by van Veen et al 64 investigated the long-term outcomes of selective neurectomy for refractory periocular synkinesis. The majority of patients were found to require recommencement of chemodenervation treatment within a median time of 1.2 years.…”

Section: Selective Neurolysismentioning

confidence: 99%

Facial synkinesis: A distressing sequela of facial palsy

et al. 2021

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Introduction Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with enduring facial paralysis, there is still a lack of complete understanding of this debilitating condition, leading to functional limitations and decreased quality of life. 1 This article reviews the diagnostic assessment, etiology, pathophysiology, rehabilitation, and nonsurgical and surgical treatments for facial synkinesis. Methods A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were “facial,” “synkinesis,” “palsy,” and various combinations of the terms. Results The resultant inability to control the full extent of one’s facial movements has functional and psychosocial consequences and may result in social withdrawal with a significant decrease in quality of life. An understanding of facial mimetic musculature is imperative in guiding appropriate intervention. While chemodenervation with botulinum toxin and neurorehabilitation have continued to be the primary treatment strategy for facial synkinesis, novel techniques such as selective myectomy, selective neurolysis, free-functioning muscle transfer, and nerve grafting techniques are becoming increasingly utilized in treatment regimens. Facial rehabilitation, including neuromuscular retraining, soft tissue massage, and relaxation therapy in addition to chemodenervation with botulinum toxin, remains the cornerstone of treatment. In cases of severe, intractable synkinesis and non-flaccid facial paralysis, surgical interventions, including selective neurectomy, selective myectomy, nerve grafting, or free muscle transfer, may play a more significant role in alleviating symptoms. Discussion A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes. Ultimately, therapy should be tailored to the severity and pattern of synkinesis, and each patient approached on a case-by-case basis. A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes.

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“…21 However, long-term follow-up demonstrated shortcomings of the original surgical approach. 22 Facial rehabilitation therapy Targeted facial neuromuscular therapy has gained widespread acceptance as a noninvasive initial treatment for NFFP. [23][24][25] A large review demonstrated targeted facial rehabilitation therapy results in quantitative improvement in facial function scores using the facial grading scale in patients with NFFP.…”

Section: Management Of Nffp Historical Treatmentsmentioning

confidence: 99%

Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy

Miller

Hadlock

2020

Facial Plastic Surgery & Aesthetic Medicine

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Many transient facial nerve insults, including Bell's palsy, Ramsay Hunt syndrome, Lyme-associated facial paralysis, and temporal bone fractures, ultimately lead to nonflaccid facial palsy (NFFP). NFFP is associated with significant functional, aesthetic, psychological, and social impairments. However, algorithms for comprehensive management of this entity are not well developed and are rapidly evolving. Herein, we present our current approach to NFFP, with the goal of providing a framework that may be applied to this complex patient population.

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Long‐term outcome of selective neurectomy for refractory periocular synkinesis

Cited by 35 publications

References 20 publications

Selective Orbicularis Neuromyectomy: A Reliable Treatment for Periocular Synkinesis

Selective Orbicularis Neuromyectomy: A Reliable Treatment for Periocular Synkinesis

Facial synkinesis: A distressing sequela of facial palsy

Beyond Botox: Contemporary Management of Nonflaccid Facial Palsy

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