Long-term outcome of selective neurectomy for refractory periocular synkinesis

The objective of this study was to investigate the long-term effect and treatment stability of selective neurectomy for refractory periocular synkinesis.

We performed a retrospective review of all patients treated with highly selective neurectomy for refractory periocular synkinesis between August 2009 and August 2015. Primary outcome was time to recommencing treatment for periocular synkinesis. Palpebral fissure width was measured preoperatively, postoperatively, and at long-term ( > 2.5 years) follow-up. Mean units of botulinum toxin used pre- and postoperatively were compared.

Of the 12 patients, 10 could be included. Only one was free of treatment for periocular synkinesis at a follow-up of 3.5 years. The other nine patients recommenced treatment with botulinum toxin after a median time of 1.2 (interquartile range 0.6-2.6) years. Palpebral fissure width while smiling was significantly different between the pre- and postoperative (P = 0.008) and preoperative and long-term (P = 0.008) measurements. Postoperatively, previously refractory patients demonstrated good response to botulinum toxin treatments.

This study demonstrates that most patients require renewed pharmacological treatment of periocular synkinesis after neurectomy. Although the effect of neurectomy in the treatment of refractory synkinesis does not appear to be sustained, patients usually experience a symptom-free interval and demonstrate larger palpebral fissure width at long-term follow-up compared to preoperative measurements.

4. Laryngoscope, 128:2291-2295, 2018.