A Comparative Study of Platysmal Myoneurectomy With Variations of Selective Neurectomies in Post‐Facial Palsy Synkinesis

TL;DR

This study compares different surgical techniques for treating facial palsy synkinesis and finds that a combined approach yields the best results.

Contribution

The paper introduces a comparative analysis of surgical variations for synkinesis treatment, highlighting the effectiveness of combined neurectomies.

Findings

All surgical groups showed significant improvement in facial function and synkinesis reduction.

Group IV, combining multiple neurectomies, achieved the best outcomes in repose and voluntary movements.

FDI-social was the only measure that did not show statistically significant improvement.

Abstract

Synkinesis is a distressing sequela of facial palsy. The main treatment for this condition has been Botulinum toxin injections. However, more recently, selective neurolysis/neurectomies have shown promise, with some variations in practice evolving over time. A clinical review of practice was performed on sixty‐eight patients (n = 68) with Bell's palsy over five years (2018–2023) who underwent synkinesis surgery, following facial palsy. Comparisons were made between platysmal myoneurectomy only (Group I), platysmal myoneurectomy and zygomaticus major/levator labii superior direct neurotization (Group II), platysmal myoneurectomy and depressor anguli oris (DAO) selective neurectomy (Group III) and platysmal myoneurectomy + DAO and buccinator selective neurectomies (Group IV). The following outcome measures were used: Sunnybrook Facial Grading Scale (FGS), Facial Clinimetric Evaluation (FaCE), Facial Disability Index (FDI), and Synkinesis Assessment Questionnaire (SAQ). Statistical analyses were performed using the student's t‐test and ANOVA. There was an overall improvement for patients pre‐ and post‐operatively (42.34 ± 16.37 vs. 65.12 ± 14.34; Student's t‐test, p < 0.0001). All FGS scores showed statistically significant (p < 0.05) improvement. FDI‐physical, SAQ, and FaCE showed statistically significant improvements, apart from the FDI‐social (p = 0.08). Qualitatively, all procedures showed significant improvement compared with their pre‐op state, with Group IV showing the best results among platysmal myoneurectomy variants in terms of repose, volitional movements, and synkinesis reduction compared with its contemporaries.

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