Selective neurectomy for nonflaccid facial palsy

Evaluation of the Patient with Facial Palsy: A Multidisciplinary Approach

This article aims to provide an overview of the management of facial palsy within a multidisciplinary team setting and discusses considerations used to develop patient-specific management plans. The national landscape of facial function services is also discussed including suggestions on what may enable a more equitable and sustainable service for the future.

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

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

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Mid-Term Effects of Selective Denervation Surgery on Facial Symmetry in Patients with Nonflaccid Facial Paralysis: Intermediate Follow-Up of Rest and Smile Symmetry

Introduction: Although selective denervation (SD) improves clinician-graded, objective, and patient-reported smile symmetry, changes in resting symmetry have not been comprehensively studied. Objective: To assess mid-term changes in resting facial symmetry after SD, and to evaluate changes in perceived emotions in faces at rest and with smiling. Methods: Nonflaccid facial paralysis (NFFP) patients undergoing SD were studied from September 2021 to October 2022. Patient-reported, clinician-graded, and objective metrics of resting and smile symmetry were quantified. Results: Fourteen patients (median age 59.5 years; median paralysis duration 76.5 months; median follow-up 249.5 days (138-400); average of 5.7 branches sacrificed) underwent SD. Resting oral commissure (OC) symmetry (p = 0.028) and upper lip symmetry (p = 0.030) improved after surgery. In smiling faces, OC excursion (p = 0.004), smile angle (p = 0.016), and dental show (p = 0.012) improved. There were significant increases in perceived happiness at rest (p = 0.006) and with smile (p = 0.002). Clinician grading revealed improved nasolabial fold depth at rest (p = 0.087) after surgery, and patients reported improved facial function and happiness with the decision to undergo surgery. Conclusion: Intermediate follow-up suggests SD can improve objective resting and smile symmetry in patients with NFFP. After surgery, patients' faces convey more happiness in repose and with smile.