Modified Selective Neurectomy for the Treatment of Post-Facial Paralysis Synkinesis

Background: In order to address functional and smile dysfunction associated with post-facial paralysis synkinesis, the senior author (BA) has offered "modified selective neurectomy" of the lower division of the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure. Methods: A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve by a single surgeon over a four-and-a-half-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale (eFACE), and OnabotulinumtoxinA BTX-A) dosages were examined before and after the procedure. Results: 63 patients underwent modified selective neurectomy between June 20, 2013 and August 12, 2017. There were no serious complications. The revision rate was 17%. Temporary oral incompetence was reported in 7 patients (11%) postoperatively. A statistically significant improvement was achieved in eFACE analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, midface and smile score. There was a significant decrease in BTX-A dosage and House-Brackmann score after the surgery. Conclusions: Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post-facial paralysis synkinesis. Financial Disclosure Statement: Dr. Massry & Azizzadeh receive royalties from Elsevier & Springer. Dr. Azizzadeh was a co-investigator for Checkpoint head and neck nerve stimulator/locator product validation study (2004). The other authors have no financial or conflicts of interest to disclose. No funding was received for this article. Corresponding Author: Babak Azizzadeh, MD, The Center for Advanced Facial Plastic Surgery, 9401 Wilshire Boulevard, Suite 650, Beverly Hills, California 90212 USA, Drazizzadeh@gmail.com ©2019American Society of Plastic Surgeons

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