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Facial Plast Surg 2024; 40(04): 525-537
DOI: 10.1055/s-0044-1786824
Original Research

Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review

Amirpouyan Namavarian   *
1   Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Emily YiQin Cheng   *
1   Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Justin Shapiro 
2   Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
,
Hedyeh Ziai
1   Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Benjamin Talei
3   Beverly Hills Center for Facial Plastic Surgery, Beverly Hills, California
,
Akshat Pai
4   Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
,
Danny Enepekides
1   Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
5   Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
,
Andres M. Gantous 
1   Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
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Abstract

Facial synkinesis is characterized by unintentional contractions of facial musculature secondary to aberrant facial nerve healing. The associated impairment in facial functioning results in a significant decrease in patients' quality of life. The mainstay treatment for postfacial paralysis synkinesis (PFPS) is chemodenervation and physiotherapy, which requires long-term maintenance neurotoxin injections. This can lead to treatment resistance. Selective neurectomy of the distal branches of the facial nerve has been suggested as an effective surgical treatment of PFPS. This study aims to provide a comprehensive systematic review evaluating the efficacy of selective neurectomy for patients presenting with PFPS. Ovid MEDLINE, Ovid Embase, PubMed, Web of Science, and CINAHL were searched from inception until July 2022. Studies that investigated postoperative outcomes of pediatric and/or adult patients who underwent selective neurectomy as a treatment for PFPS were included. The database search identified 1,967 studies, and 11 were ultimately included based on inclusion and exclusion criteria. These 11 studies represented 363 patients. Studies reported on outcomes following selective neurectomy with or without adjuvant therapies for patients with PFPS. The main outcome categories identified were clinician-reported outcomes and patient-reported outcomes. The studies that used clinician-reported outcomes found an improvement in both synkinesis and facial nerve paralysis (FNP) outcomes following selective neurectomy according to their respective grading systems. Three studies looked at patient-reported outcomes and found increased patient-reported quality of life and satisfaction following selective neurectomy. The most reported complications were upper lip contracture, uneven cheek surface, lagophthalmos, and temporary oral incompetence. Selective neurectomy has demonstrated stable or improved synkinesis, FNP, and quality of life outcomes in patients with PFPS. This approach should be considered for patients with PFPS, particularly for patients with refractory symptoms or those who are unable to undergo continued medical management.

Keywords

synkinesis - selective neurectomy - facial nerve paralysis

* These authors have contributed equally to this article and are considered co-first authors.




Publication History

Article published online:
28 May 2024

© 2024. Thieme. All rights reserved.

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