Selective Facial Neurectomy for Spastic Disorders of the Facial Nerve

Abstract

Selective facial neurectomy in combination with bilateral musculocutaneous resection, plication brow lift, upper lid blepharoplasty, and limited rhytidectomy was performed on 18 patients with essential blepharospasm, eight with hemifacial spasm, and two with CNS vascular compression malformations. Microscopy showed the nerve tissues to be normal. Initial results were excellent. At 3 months there was a slight, persistent spastic twitching of the affected muscles in five nerves (a 14% failure rate in correcting blepharospasm). After 13 months there were four additional failures resulting from nerve regrowth in three and from one patient not completing therapy. The overall blepharospasm failure rate was 26%. On repeat neurectomy those with nerve regrowth presented with a diffuse, fine meshwork of nerve fibers reinnervating the mimetic facial musculature. In six of seven patients operated on again, spasticity was eliminated. The initial surgical failure rate has been corrected by resecting the frontal branch and the superior division of the buccal branch of the facial nerve. Only repeat neurectomy can correct long-term failures resulting from facial nerve regrowth.

Neural repair in facial paralysis: Clinical and experimental studies

“…The main difference between the two regenerating nerve models was the presence of neural arborization with collateral axons in the extrafascicular connective tissue of the nerve graft [24]. Similar collateral axonal branching was seen in patients with severe synkinesis who were surgically explored in order to diminish this aberrant motor activity [15,16,21]. It appeared that synkinesis was related to aberrant innervations of striated muscles of facial expression by regenerating neurite collaterals.…”

Neural repair in facial paralysis: Clinical and experimental studies

“…The main difference between the two regenerating nerve models was the presence of neural arborization with collateral axons in the extrafascicular connective tissue of the nerve graft [24]. Similar collateral axonal branching was seen in patients with severe synkinesis who were surgically explored in order to diminish this aberrant motor activity [15,16,21]. It appeared that synkinesis was related to aberrant innervations of striated muscles of facial expression by regenerating neurite collaterals.…”

Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review

“…Studies were excluded if they met any of the following criteria: (1) non-English articles, (2) articles that did not use selective neurectomy as a treatment for PFPS, or (3) selective neurectomy for treatment of only non-PFPS conditions (e.g., blepharospasm, hemifacial spasm). 8 All etiologies of FNP were included in this study.…”

Neural repair in facial paralysis: Clinical and experimental studies

“…The main difference between the two regenerating nerve models was the presence of neural arborization with collateral axons in the extrafascicular connective tissue of the nerve graft [24]. Similar collateral axonal branching was seen in patients with severe synkinesis who were surgically explored in order to diminish this aberrant motor activity [15,16,21]. It appeared that synkinesis was related to aberrant innervations of striated muscles of facial expression by regenerating neurite collaterals.…”

Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review

“…Studies were excluded if they met any of the following criteria: (1) non-English articles, (2) articles that did not use selective neurectomy as a treatment for PFPS, or (3) selective neurectomy for treatment of only non-PFPS conditions (e.g., blepharospasm, hemifacial spasm). 8 All etiologies of FNP were included in this study.…”

Neural repair in facial paralysis: Clinical and experimental studies

“…The main difference between the two regenerating nerve models was the presence of neural arborization with collateral axons in the extrafascicular connective tissue of the nerve graft [24]. Similar collateral axonal branching was seen in patients with severe synkinesis who were surgically explored in order to diminish this aberrant motor activity [15,16,21]. It appeared that synkinesis was related to aberrant innervations of striated muscles of facial expression by regenerating neurite collaterals.…”

Selective Neurectomy for Postfacial Paralysis Synkinesis: A Systematic Review

“…Studies were excluded if they met any of the following criteria: (1) non-English articles, (2) articles that did not use selective neurectomy as a treatment for PFPS, or (3) selective neurectomy for treatment of only non-PFPS conditions (e.g., blepharospasm, hemifacial spasm). 8 All etiologies of FNP were included in this study.…”