Download PDF
J Reconstr Microsurg 2024; 40(09): 665-671
DOI: 10.1055/a-2273-4327
Original Article

Postparetic Synkinesis: Objective and Subjective Comparisons of Depressor Anguli Oris Myectomies versus Depressor Anguli Oris and Buccinator Myectomies

Cristina V. Sanchez
1   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Alp Ercan
1   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Shai M. Rozen
1   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Muscles affected by postparetic synkinesis have imbalanced tonicity that limit perioral mimetic movement and inhibit the ability to smile. The depressor anguli oris (DAO) muscle has been a common myectomy target for the treatment of perioral synkinesis. While addition of buccinator myectomies to DAO myectomies has risen, no studies have analyzed the effects of buccinator myectomies. The goal of this study was to evaluate and compare the effects of a DAO myectomy with and without concomitant buccinator myectomy through objective facial metrics and subjective patient-reported outcomes.

Methods This study is a retrospective review of patients with postparetic synkinesis who underwent DAO myectomy (DAO myectomy group) or DAO myectomy with buccinator myectomy (DAO + Buccinator myectomies group). Outcomes included postoperative differences in objective smile measures (smile angle, excursion, and dental show) using validated software and patient-reported outcomes using the Facial Disability Index (FDI) questionnaire and a myectomy-specific questionnaire.

Results After chart review, 18 patients were included in the DAO myectomy group and 19 in the DAO + Buccinator myectomies group. There were no significant postoperative differences between the groups in (1) smile excursion, angle, or dental show at resting, closed smile, or open smile (p > 0.05), (2) FDI physical and social scores, p = 0.198 and 0.932, respectively, or (3) myectomy-specific questionnaire responses (p > 0.05).

Conclusion The addition of a buccinator myectomy to a DAO myectomy does not provide significant clinical benefit when compared with an isolated DAO myectomy, based on objective measures and subjective patient-reported outcomes.

Keywords

synkinesis - facial paralysis - myectomies


Publication History

Received: 16 October 2023

Accepted: 15 February 2024

Accepted Manuscript online:
21 February 2024

Article published online:
18 March 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kanerva M. Buccinator synkinesis treated by botulinum toxin in facial palsy and hemifacial spasms. J Plast Reconstr Aesthet Surg 2021; 74 (07) 1464-1469
    CrossrefPubMedGoogle Scholar
  • 2 Sanchez A, Pannu J, Fuller JC. Facial paralysis: timing of repair and management of the nonflaccidly paralyzed face. Curr Opin Otolaryngol Head Neck Surg 2021; 29 (04) 265-270
    CrossrefPubMedGoogle Scholar
  • 3 Patel PN, Owen SR, Norton CP. et al. Outcomes of buccinator treatment with botulinum toxin in facial synkinesis. JAMA Facial Plast Surg 2018; 20 (03) 196-201
    CrossrefPubMedGoogle Scholar
  • 4 Tavares H, Oliveira M, Costa R, Amorim H. Botulinum toxin type A injection in the treatment of postparetic facial synkinesis: an integrative review. Am J Phys Med Rehabil 2022; 101 (03) 284-293
    CrossrefPubMedGoogle Scholar
  • 5 Wei LA, Diels J, Lucarelli MJ. Treating buccinator with botulinum toxin in patients with facial synkinesis: a previously overlooked target. Ophthal Plast Reconstr Surg 2016; 32 (02) 138-141
    CrossrefPubMedGoogle Scholar
  • 6 Husseman J, Mehta RP. Management of synkinesis. Facial Plast Surg 2008; 24 (02) 242-249
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Chuang DC, Chang TN, Lu JC. Postparalysis facial synkinesis: clinical classification and surgical strategies. Plast Reconstr Surg Glob Open 2015; 3 (03) e320
    CrossrefPubMedGoogle Scholar
  • 8 Chuang DC, Chang TN, Lu JC, Zavala A. Surgical treatment for postparalytic facial synkinesis: a 35-year experience. Plast Reconstr Surg 2022; 150 (03) 631-643
    CrossrefPubMedGoogle Scholar
  • 9 Derakhshan A, Miller MQ, Malka R, Gadkaree SK, Hadlock TA. Releasing the smile: depressor anguli oris excision in the context of managing nonflaccid facial palsy. Plast Reconstr Surg 2022; 149 (02) 261e-269e
    CrossrefPubMedGoogle Scholar
  • 10 Guerrissi JO. Selective myectomy for postparetic facial synkinesis. Plast Reconstr Surg 1991; 87 (03) 459-466
    CrossrefPubMedGoogle Scholar
  • 11 Halani SH, Sanchez CV, Hembd AS, Mohanty AJ, Reisch J, Rozen SM. Depressor anguli oris myectomy versus transfer to depressor labii inferioris for facial symmetry in synkinetic facial paralysis. J Reconstr Microsurg 2022; 38 (04) 328-334
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Hembd AS, Sanchez CV, Halani SH, Mohanty AJ, Krag AE, Rozen SM. Do preoperative depressor anguli oris muscle blocks predict myectomy outcomes? A single-cohort comparison in postparetic facial synkinesis. Plast Reconstr Surg 2022; 150 (01) 163-167
    CrossrefPubMedGoogle Scholar
  • 13 Jowett N, Malka R, Hadlock TA. Effect of weakening of ipsilateral depressor anguli oris on smile symmetry in postparalysis facial palsy. JAMA Facial Plast Surg 2017; 19 (01) 29-33
    CrossrefPubMedGoogle Scholar
  • 14 Terzis JK, Karypidis D. Therapeutic strategies in post-facial paralysis synkinesis in adult patients. Plast Reconstr Surg 2012; 129 (06) 925e-939e
    CrossrefPubMedGoogle Scholar
  • 15 Bassilios Habre S, Googe BJ, Depew JB, Wallace RD, Konofaos P. Depressor reanimation after facial nerve paralysis. Ann Plast Surg 2019; 82 (05) 582-590
    CrossrefPubMedGoogle Scholar
  • 16 Krag AE, Glick S, Hembd A, Rozen SM. The effect of depressor anguli oris muscle block on facial symmetry in synkinetic facial paralysis patients and its role in preoperative assessment. Plast Reconstr Surg 2021; 147 (03) 455-465
    CrossrefPubMedGoogle Scholar
  • 17 Rozen SM. Discussion: Surgical treatment for postparalytic facial synkinesis: a 35-year experience. Plast Reconstr Surg 2022; 150 (03) 644-645
    CrossrefPubMedGoogle Scholar
  • 18 Azizzadeh B, Irvine LE, Diels J. et al. Modified selective neurectomy for the treatment of post–facial paralysis synkinesis. Plast Reconstr Surg 2019; 143 (05) 1483-1496
    CrossrefPubMedGoogle Scholar
  • 19 Schneider CA, Rasband WS, Eliceiri KW. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9 (07) 671-675
    CrossrefPubMedGoogle Scholar
  • 20 Guarin DL, Dusseldorp J, Hadlock TA, Jowett N. A machine learning approach for automated facial measurements in facial palsy. JAMA Facial Plast Surg 2018; 20 (04) 335-337
    CrossrefPubMedGoogle Scholar
  • 21 VanSwearingen JM, Brach JS. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther 1996; 76 (12) 1288-1298 , discussion 1298–1300
    CrossrefPubMedGoogle Scholar