Selective Neurectomy with Regenerative Peripheral Nerve Interface Surgery for Facial Synkinesis.

Background

Selective neurectomy (SN) typically leaves cut nerve endings to be either free-floating or buried in facial muscles. Regenerative peripheral nerve interfaces (RPNIs) use autologous skeletal muscle grafts to provide a nonfacial muscle target for reinnervation.

Objective

To evaluate the effectiveness of RPNI surgery with SN for improving postoperative facial function through botulinum toxin use and facial movement metrics.

Methods

This was a retrospective cohort study comparing patients with synkinesis undergoing SN with and without RPNI surgery. Outcomes included assessing botulinum toxin dosage/frequency and facial movement metrics (margin to reflex distance, brow movement, smile excursion). Statistical tests were applied based on variable distribution.

Results

Twenty-four patients were included (12 with RPNI surgery and 12 without; average age, 52.3 and 55.0 years, respectively; p = 0.552). No significant differences were observed in etiology or nerves sacrificed. Patients with RPNI surgery required lower botulinum toxin dosage (72.2 vs. 90.3 units; p = 0.031) and had longer treatment intervals (83.5%, 5.6 months vs. 17.9%, 4.6 months; p = 0.015). No significant differences were observed in facial movement metrics.

Conclusion

RPNI surgery with SN may improve facial function as measured by a proxy of reduction in postoperative botulinum toxin dosage and frequency.