Facial plastic surgery & aesthetic medicine · 2026
A Zonal Denervation Approach to Surgical Management of Facial Synkinesis.
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Xiao Roy, McGonagle Elizabeth R, Roy Catherine F, Hadlock Tessa A
Аннотация
BACKGROUND: While selective neurectomy has emerged as a surgical adjunct for patients with facial synkinesis to eliminate aberrantly regenerated axons, postoperative outcomes have been mixed.
OBJECTIVE: To understand how a zonal denervation approach to selective neurectomy targeting a broader elimination of unwanted neural elements can affect periocular and perioral movements among patients with facial synkinesis.
METHODS: We retrospectively assessed patients who underwent zonal denervation from July 2023 through August 2024. Pre- and postoperative photographs were analyzed in a blinded fashion using Emotrics and eFACE; postoperative changes were compared within patients using Wilcoxon matched-pairs signed rank tests.
RESULTS: We included 20 zonal denervation patients who were primarily female (90%) with median age of 51 years (interquartile range 42-63) and most often developed initial facial paralysis due to viral etiology (45%). These patients experienced significant improvement in median oral commissure excursion from 2.50 mm to 5.88 mm (p < 0.001) at median 12-month follow-up (interquartile range 9-14 months). Median interlabial distance difference decreased from 5.23 mm to 2.64 mm (p = 0.002), while median palpebral fissure width difference decreased from 2.98 mm to 1.01 mm (p = 0.003). eFACE outcomes mirrored Emotrics improvements. Six patients (30%) developed transient oral incompetence resolving in less than 6 months in all cases.
CONCLUSIONS: Zonal denervation is an effective technique to improve periocular and perioral synkinesis.
OBJECTIVE: To understand how a zonal denervation approach to selective neurectomy targeting a broader elimination of unwanted neural elements can affect periocular and perioral movements among patients with facial synkinesis.
METHODS: We retrospectively assessed patients who underwent zonal denervation from July 2023 through August 2024. Pre- and postoperative photographs were analyzed in a blinded fashion using Emotrics and eFACE; postoperative changes were compared within patients using Wilcoxon matched-pairs signed rank tests.
RESULTS: We included 20 zonal denervation patients who were primarily female (90%) with median age of 51 years (interquartile range 42-63) and most often developed initial facial paralysis due to viral etiology (45%). These patients experienced significant improvement in median oral commissure excursion from 2.50 mm to 5.88 mm (p < 0.001) at median 12-month follow-up (interquartile range 9-14 months). Median interlabial distance difference decreased from 5.23 mm to 2.64 mm (p = 0.002), while median palpebral fissure width difference decreased from 2.98 mm to 1.01 mm (p = 0.003). eFACE outcomes mirrored Emotrics improvements. Six patients (30%) developed transient oral incompetence resolving in less than 6 months in all cases.
CONCLUSIONS: Zonal denervation is an effective technique to improve periocular and perioral synkinesis.