Thirty-five year experience of an aggressive surgical intervention for treating post-paralytic facial synkinesis: an outcome study

Aim: Combined neurectomy & myectomy and functioning free muscle transplantation is proposed as an aggressive surgical intervention for postparalytic facial synkinesis (PPFS) to effectively resolve the problem since 1985 and this treatment continues to be the standard. We aim to describe our experiences with 103 PPFS patients who underwent the surgical treatment. Methods: A total of 103 patients with PPFS were investigated (1985-2020), but 94 were selected with all having at least one year of postoperative follow-up. Among them 50 were Type II and 44 were Type III PPFS. All patients underwent extensive removal of the synkinetic muscles and triggered facial nerve branches in the cheek, nose and neck regions, followed by gracilis transplantation for facial reanimation. Results: The incidence of receiving the aggressive surgical intervention increased from 15% prior to 2012 up to 24%. The mean postoperative follow-up period was 10 years. Young adult (79%) and female patients (63%) were the dominant populations, showing their great ambition for a treatment. Results showed a significant improvement in facial smile with more teeth visible, and a significant decrease in facial synkinesis. About 96% (90 patients) did not require botulinum toxin A injection after surgery. Revision surgery for secondary deformity was approximately 53%. Conclusion: Treatment of PPFS is primarily reconstructive. Combined myectomy & neurectomy and functioning free muscle transplantation for Type II and III patients are well accepted, and leads to promising and long-lasting results despite higher revision rates. Refined techniques to decrease revision rates are needed.