Selective neurectomy for nonflaccid facial palsy

Abstract

Purpose of review To review the evolving role of selective neurectomy in the management of patients with synkinesis including the history of selective neurectomy, operative techniques, and clinical outcomes. Recent findings Modified selective neurectomy alone or in conjunction with other procedures achieves more durable outcomes based on objective measures such as time to recurrence of symptoms and units of botulinum toxin required postoperatively. This is also reflected on patient reported quality of life outcome measures. Regarding operative technique, lower rates of oral incompetence are reported with division of an average of 6.7 nerve branches as opposed to more branches. Summary Chemodenervation has long been the mainstay of treatment in facial synkinesis, but in recent years, the paradigm has begun to shift in favor of incorporating interventions with more durable outcomes such as modified selective neurectomy. Modified selective neurectomy is often performed with other simultaneous surgeries such as nerve transfer, rhytidectomy, lid surgery and static facial reanimation primarily to address periocular synkinesis and synkinetic smile. The outcomes have been favorable with improvement in quality-of-life measures and a decrease in botulinum toxin requirements.

Evaluation of the Patient with Facial Palsy: A Multidisciplinary Approach

“…50 Studies have demonstrated significant improvements in patient-reported smile outcomes, facial tightness, and discomfort and a reduced need for botulinum toxin use. [50][51][52] However, oral incompetence and articulation difficulties are recognized complications of this procedure. 51,52 Electrical stimulation can be used to promote the stimulation of muscles during the denervation period, thereby promoting functional recovery.…”

“…[50][51][52] However, oral incompetence and articulation difficulties are recognized complications of this procedure. 51,52 Electrical stimulation can be used to promote the stimulation of muscles during the denervation period, thereby promoting functional recovery. 53,54 Despite some success in treating patients with acute Bell's palsy, 55 it has been suggested that stimulation could disrupt reinnervation and be counterproductive in improving overall facial nerve function by inducing synkinesis and is not used in our center.…”