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Selective neurectomy for nonflaccid facial palsy
Alyssa K Ovaitt1, Cynthia M Chweya, John Flynn
1Department of Otolaryngology-Head and Neck Surgery. University of Kansas Medical Center, Kansas City, Kansas, USA.
Summary
Modified selective neurectomy offers durable outcomes for facial synkinesis management, reducing symptom recurrence and botulinum toxin needs. This surgical approach improves patient quality of life compared to traditional chemodenervation.
Area of Science:
- Neurology
- Plastic Surgery
- Ophthalmology
Background:
- Facial synkinesis, often a sequela of facial nerve injury, presents significant challenges in management.
- Chemodenervation, primarily with botulinum toxin, has been the standard treatment, but often requires repeated administration.
- The need for more sustainable interventions has driven the evolution of surgical techniques.
Approach:
- This review examines the historical context and current applications of selective neurectomy in treating facial synkinesis.
- Operative techniques, including modifications and adjunct procedures, are detailed.
- Clinical outcomes, focusing on symptom recurrence, quality of life, and complication rates, are analyzed.
Key Points:
- Modified selective neurectomy demonstrates superior durability compared to chemodenervation, evidenced by longer symptom-free intervals and reduced botulinum toxin requirements.
- Patient-reported quality of life measures show significant improvement following selective neurectomy.
- Optimized surgical techniques, involving the division of approximately 6.7 nerve branches, are associated with lower rates of oral incompetence.
Conclusions:
- The paradigm for facial synkinesis management is shifting towards durable surgical interventions like modified selective neurectomy.
- This procedure is frequently combined with other surgeries, such as nerve transfers and rhytidectomy, particularly for periocular synkinesis and synkinetic smile.
- Outcomes are favorable, with enhanced quality of life and decreased reliance on botulinum toxin.
