A Zonal Denervation Approach to Surgical Management of Facial Synkinesis

While selective neurectomy has emerged as a surgical adjunct for patients with facial synkinesis to eliminate aberrantly regenerated axons, postoperative outcomes have been mixed.

To understand how a zonal denervation approach to selective neurectomy targeting a broader elimination of unwanted neural elements can affect periocular and perioral movements among patients with facial synkinesis.

We retrospectively assessed patients who underwent zonal denervation from July 2023 through August 2024. Pre- and postoperative photographs were analyzed in a blinded fashion using Emotrics and eFACE; postoperative changes were compared within patients using Wilcoxon matched-pairs signed rank tests.

We included 20 zonal denervation patients who were primarily female (90%) with median age of 51 years (interquartile range 42-63) and most often developed initial facial paralysis due to viral etiology (45%). These patients experienced significant improvement in median oral commissure excursion from 2.50 mm to 5.88 mm (p < 0.001) at median 12-month follow-up (interquartile range 9-14 months). Median interlabial distance difference decreased from 5.23 mm to 2.64 mm (p = 0.002), while median palpebral fissure width difference decreased from 2.98 mm to 1.01 mm (p = 0.003). eFACE outcomes mirrored Emotrics improvements. Six patients (30%) developed transient oral incompetence resolving in less than 6 months in all cases.

Zonal denervation is an effective technique to improve periocular and perioral synkinesis.