Surgical Treatment for Postparalytic Facial Synkinesis — A 35 Year Experience

Abstract

ostparalytic facial synkinesis is a sequela after recovery of facial paralysis, resulting in involuntary and unwanted facial muscle movements during facial animation. There are various clinical presentations, such as synkinesis between mouth and eye, synkinesis between mouth and neck, and many others. [1][2][3][4] With advanced microneurovascular surgery, nerve transfer and functioning free muscle transplantation has become the primary operation for the reconstruction of longstanding facial paralysis. [5][6][7][8][9][10][11][12][13] However, the treatment of postparalytic facial synkinesis remains challenging and controversial. The mechanism of postparalytic facial synkinesis is extensively studied, but not well understood. [1][2][3][4] Recommended surgical treatments for postparalytic facial synkinesis in the literature include trunk neurectomy, 14 selective neurectomy, 15,16 highly selective neurectomy, 17 modified midface selective neurectomy, 18 selective myotomy or myectomy, 19,20 and extensive neurectomy and myectomy in the cheek and neck regions followed by functioning free muscle transplantation. 21 Each method has its advantages and disadvantages. The aim of this article is to give a comprehensive review of type II and III postparalytic facial synkinesis patients who underwent extensive reconstructive surgery at a single institution.

Postparetic Synkinesis: Objective and Subjective Comparisons of Depressor Anguli Oris Myectomies versus Depressor Anguli Oris and Buccinator Myectomies

“…In recent years, surgical algorithms for patients with post-paretic synkinesis have grown in popularity, including muscle myectomies. [7][8][9]15,17 Myectomy targets include muscles that have responded well to chemodenervation or lidocaine blocks, such as the DAO. Studies have shown equivocal results after chemodenervation of the buccinator muscle and no information on the effects of buccinator myectomies.…”

“…The most common perioral muscles affected by this phenomenon include the depressor anguli oris (DAO), platysma, mentalis, and buccinator. 2 Previously reported treatment options include chemo-denervation, [3][4][5][6] muscle myectomy, [6][7][8][9][10][11][12][13][14][15][16][17] and selective neurectomies, 10,17,18 as well as free functional muscle transfers, 2,8,14 muscle neurotization, 14 cross-facial nerve grafts, 7 and nerve transfers. 2,14 Though no consensus exists as to the treatment strategy for synkinetic patients, the guiding principle is restoring facial balance by strengthening weak and weakening hyper-toned facial regions.…”

Approaches to the Management of Synkinesis: A Scoping Review

“…53 For patients with moderate-to-severe synkinesis, especially when combined with an unacceptable smile, a more radical approach with combined myectomy and neurectomy followed by free functioning muscle transplantation has been proposed. 54 Following extensive neuromyectomies of the synkinetic muscles and triggering facial nerve branches in the cheek, nose, and neck regions, a free functioning gracilis flap is used for hemifacial reanimation. Although reporting good outcomes for synkinesis control and smile reanimation, revision surgery for secondary deformity was necessary in 53%.…”

Facial Paralysis Treatment Using Selective Neurectomy: A Comprehensive Review

“…Chuang et al's study aimed to present proof that this surgical approach is successful in treating synkinesis and improving the quality of smiles. The authors concluded that the combination of myectomy and neurectomy, along with functioning free muscle transplantation, offers hopeful and enduring outcomes for synkinetic patients with type II and III, even though there may be a significant need for revisions [ 44 ]. Moreover, according to Bran et al Selective neurolysis seems to be a highly effective alternative approach for treating facial nerve syndrome, a condition that greatly affects one's quality of life due to movement disorders when there is no therapeutic improvement observed with Botox A [ 45 ].…”