Skip to main content
SpringerLink
Log in

How to Enhance the Success of Selective Neurectomy for Facial Synkinesis by Considering the Patient's Preferences: Lesson Learned from a Retrospective Analysis of 122 Cases

  • Original Articles
  • Face and Neck Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Facial synkinesis can result in facial tightness, smile dysfunction, and eyelid aperture narrowing due to overactive and uncoordinated muscle activity. We hypothesized that the outcome of a selective neurectomy could rely on the patient’s chief complaints.

Methods

We retrospectively reviewed 122 patients who underwent selective neurectomy at our hospital. Preoperatively, the patients were asked nine questionnaires to identify their two major chief complaints (treatment priorities). Postoperatively, facial tightness, limited mouth movement, and eyelid aperture narrowing were measured.

Results

The most common chief complaints in our series were facial tightness (n=38), eyelid narrowing (n=32), and limited mouth movement (n=28); the second most common chief complaints (second priority) were limited mouth movement (n=47), facial tightness (n=21), and eyelid narrowing (n=20). The mean score for facial tightness significantly improved from 4.3 to 1.1 in the first priority group. Among the 28 patients whose corners of the mouth constituted the top priority of surgical correction, the vertical inclination on the affected side significantly improved from 74.1 ± 7.6° to 55.5 ± 6.0°, and the horizontal angles were changed from 4.2 ± 2.7° to 2.0 ± 1.3° after selective neurectomy without statistically significant. Among the 32 patients for whom eyelid narrowing constituted the top priority, the mean eyelid narrowing score improved from 4.5 ± 1.1 to 1.5 ± 1.2.

Conclusions

Selective neurectomy can provide a significantly satisfactory outcome regarding facial tightness and eyelid aperture narrowing. The vertical inclination of the mouth corner can be significantly improved, while the improvement of horizontal angles can be suboptimal.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Peitersen E (2002) Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 549:4–30

    Article  Google Scholar 

  2. Yamamoto E, Nishimura H, Hirono Y (1988) Occurrence of sequelae in Bell’s palsy. Acta Otolaryngol Suppl 446:93–96

    CAS  PubMed  Google Scholar 

  3. Terzis JK, Karypidis D (2012) Therapeutic strategies in post-facial paralysis synkinesis in adult patients. Plast Reconstr Surg 129(6):925e-e939

    Article  CAS  PubMed  Google Scholar 

  4. Chuang DC-C, Chang TN-J, Lu JC-Y, Zavala A (2022) Surgical treatment for postparalytic facial synkinesis: a 35-year experience. Plast Reconstr Surg 150(3):631–43

    Article  CAS  PubMed  Google Scholar 

  5. Azizzadeh B, Irvine LE, Diels J, Slattery WH, Massry GG, Larian B, Riedler KL, Peng GL (2019) Modified selective neurectomy for the treatment of post-facial paralysis synkinesis. Plast Reconstr Surg 143(5):1483–1496

    Article  CAS  PubMed  Google Scholar 

  6. Breslow GD, Cabiling D, Kanchwala S, Bartlett SP (2005) Selective marginal mandibular neurectomy for treatment of the marginal mandibular lip deformity in patients with chronic unilateral facial palsies. Plast Reconstr Surg 116(5):1223–1232

    Article  CAS  PubMed  Google Scholar 

  7. Isken T, Gunlemez A, Kara B, Izmirli H, Gercek H (2009) Botulinum toxin for the correction of asymmetric crying facies. Aesthetic Surg J 29(6):524–527

    Article  Google Scholar 

  8. Terzis JK, Rose EH, Manktelow R, Walton RL (2005) Facial nerve injury: diagnosis and repair. Aesthetic Surg J 25(5):495–505

    Article  Google Scholar 

  9. Bran GM, Lohuis PJ (2014) Selective neurolysis in post-paralytic facial nerve syndrome (PFS). Aesthetic Plast Surg 38(4):742–744

    Article  PubMed  Google Scholar 

  10. Lee JM, Choi KH, Lim BW, Kim MW, Kim J (2015) Half-mirror biofeedback exercise in combination with three botulinum toxin A injections for long-lasting treatment of facial sequelae after facial paralysis. J Plast Reconstr Aesthet Surg 68(1):71–78

    Article  PubMed  Google Scholar 

  11. Choi KH, Rho SH, Lee JM, Jeon JH, Park SY, Kim J (2013) Botulinum toxin injection of both sides of the face to treat post-paralytic facial synkinesis. J Plast Reconstr Aesthet Surg 66(8):1058–1063

    Article  PubMed  Google Scholar 

  12. Jeong J, Lee JM, Kim J (2023) Neuromuscular retraining therapy combined with preceding botulinum toxin A injection for chronic facial paralysis. Acta Otolaryngol 143(5):446–451

    Article  CAS  PubMed  Google Scholar 

  13. Leader B, Griffin GR, Larian B, Massry G, Nabili V, Slattery W, Azizzadeh B (2021) End-to-trunk masseteric to facial nerve transfer with selective neurectomy for facial reanimation. J Craniofac Surg 32(8):2864–2866

    Article  PubMed  Google Scholar 

  14. Shikara M, Bridgham K, Ludeman E, Vakharia K, Justicz N (2023) Selective neurectomy for treatment of post-facial paralysis synkinesis: a systematic review. Facial Plast Surg 39(2):190–200

    Article  CAS  PubMed  Google Scholar 

  15. van Veen MM, Dusseldorp JR, Hadlock TA (2018) Long-term outcome of selective neurectomy for refractory periocular synkinesis. Laryngoscope 128(10):2291–2295

    Article  PubMed  Google Scholar 

  16. Ovaitt AK, Chweya CM, Flynn J (2023) Selective neurectomy for nonflaccid facial palsy. Curr Opin Otolaryngol Head Neck Surg 31(4):244–247

    Article  PubMed  Google Scholar 

  17. Shokri T, Patel S, Weller C, Lighthall JG (2023) A surgeon’s armamentarium for ocular management in facial paralysis: a comprehensive review. J Craniofac Surg 34(1):214–221

    Article  PubMed  Google Scholar 

  18. Guntinas-Lichius O, Prengel J, Cohen O, Mäkitie AA, Vander Poorten V, Ronen O, Shaha A, Ferlito A (2022) Pathogenesis, diagnosis and therapy of facial synkinesis: a systematic review and clinical practice recommendations by the international head and neck scientific group. Front Neurol 13:1019554

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bayrak SB, Kriet JD, Humphrey CD (2017) Masseteric to buccal branch nerve transfer. Curr Opin Otolaryngol Head Neck Surg 25(4):280–285

    Article  PubMed  Google Scholar 

  20. Daane SP, Owsley JQ (2003) Incidence of cervical branch injury with “marginal mandibular nerve pseudo-paralysis” in patients undergoing face lift. Plast Reconstr Surg 111(7):2414–2418

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, 18450, South Korea

    Tae Hwan Park, Il Seok Park & Jin Kim

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, South Korea

    Tae Hwan Park, Il Seok Park & Jin Kim

Authors
  1. Tae Hwan Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Il Seok Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Kim.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.)

Ethical Approval

The displayed study was carried out with respect to high ethical standards. All the studies have been approved, when required, by the appropriate ethics committee and have, therefore, been performed in accordance and in conformity with the World Medical Association Declaration of Helsinki (June 1964) and subsequent amendments.

Informed Consent

All patients signed an informed consent for the procedures. For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

266_2023_3620_MOESM1_ESM.jpg

Supplement Figure 1. Hematoxylin and eosin and S100 staining (×50 and ×100) of the removed nerve segments. Varying amounts of degenerative Schwann cells and the absence of nuclei in atrophic cells were observed, along with Wallerian degeneration (characterized by degenerative Schwann cells, atrophic changes, macrophages, and the absence of nuclei). The distribution of synkinetic nerve fibers considerably differed among the terminal branches of the facial nerves.

266_2023_3620_MOESM2_ESM.jpg

Supplement Figure 2. This is a 49-year-old female patient with facial paralysis by Ramsay Hunt syndrome. She underwent multiple botulinum toxin A injections and physical therapy for 4 years without significant improvement. Her first priority was limited mouth excursion, and her second priority was facial tightness. Intraoperatively, Z2-4, B3-6, MM2, C2 were clipped.

266_2023_3620_MOESM3_ESM.jpg

Supplement Figure 3. This is a 49-year-old female patient with facial paralysis by Ramsay Hunt syndrome. She underwent multiple botulinum toxin A injections and physical therapy for four years without significant improvement. Her first priority was limited mouth excursion, and her second was facial tightness. Intraoperatively, Z2-4, B3-6, MM2, C2 were clipped.

266_2023_3620_MOESM4_ESM.jpg

Supplement Figure 4. This is a 34-year-old female patient with facial paralysis following Bell’s palsy. She underwent multiple botulinum toxin A injections and physical therapy for two years without significant improvement. Her first priority was limited mouth excursion, and her second was facial tightness. Intraoperatively, Z2-4, B3-6, MM2 were clipped.

266_2023_3620_MOESM5_ESM.jpg

Supplement Figure 5. This is a 47-year-old female patient with facial paralysis following Bell’s palsy. She underwent multiple botulinum toxin A injections for two years without significant improvement. Her first priority was eyelid aperture narrowing, and her second was facial tightness. Intraoperatively, Z1-7, B3-7, MM2 were clipped.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Park, T.H., Park, I.S. & Kim, J. How to Enhance the Success of Selective Neurectomy for Facial Synkinesis by Considering the Patient's Preferences: Lesson Learned from a Retrospective Analysis of 122 Cases. Aesth Plast Surg 48, 1249–1257 (2024). https://doi.org/10.1007/s00266-023-03620-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03620-8

Keywords

Search

Navigation