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Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review.
Amirpouyan Namavarian1, Emily YiQin Cheng1, Justin Shapiro2
1Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Facial Plastic Surgery : FPS
|May 28, 2024
Summary
Selective neurectomy offers a promising surgical option for post-facial paralysis synkinesis (PFPS), improving facial function and quality of life. This approach is particularly beneficial for patients with persistent symptoms or those resistant to traditional treatments.
Area of Science:
- Neurology
- Otolaryngology
- Plastic Surgery
Background:
- Facial synkinesis, involuntary facial muscle contractions post-nerve injury, significantly impacts quality of life.
- Current treatments like chemodenervation require ongoing injections and can lead to resistance.
- Selective neurectomy presents a surgical alternative for managing postfacial paralysis synkinesis (PFPS).
Approach:
- A systematic review was conducted, searching multiple databases (Ovid MEDLINE, Embase, PubMed, Web of Science, CINAHL) up to July 2022.
- Included studies focused on pediatric and adult patients undergoing selective neurectomy for PFPS.
- Eleven studies, encompassing 363 patients, were analyzed for postoperative outcomes.
Key Points:
- Clinician-reported outcomes showed improvements in both synkinesis and facial nerve paralysis (FNP) post-surgery.
- Patient-reported outcomes indicated enhanced quality of life and satisfaction.
- Common complications included upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence.
Conclusions:
- Selective neurectomy demonstrates efficacy in stabilizing or improving synkinesis, FNP, and quality of life in PFPS patients.
- This surgical option should be considered, especially for refractory cases or when long-term medical management is not feasible.
