Mid-Term Effects of Selective Denervation Surgery on Facial Symmetry in Patients with Nonflaccid Facial Paralysis: Intermediate Follow-Up of Rest and Smile Symmetry.

Introduction

Although selective denervation (SD) improves clinician-graded, objective, and patient-reported smile symmetry, changes in resting symmetry have not been comprehensively studied.

Objective

To assess mid-term changes in resting facial symmetry after SD, and to evaluate changes in perceived emotions in faces at rest and with smiling.

Methods

Nonflaccid facial paralysis (NFFP) patients undergoing SD were studied from September 2021 to October 2022. Patient-reported, clinician-graded, and objective metrics of resting and smile symmetry were quantified.

Results

Fourteen patients (median age 59.5 years; median paralysis duration 76.5 months; median follow-up 249.5 days (138-400); average of 5.7 branches sacrificed) underwent SD. Resting oral commissure (OC) symmetry (p = 0.028) and upper lip symmetry (p = 0.030) improved after surgery. In smiling faces, OC excursion (p = 0.004), smile angle (p = 0.016), and dental show (p = 0.012) improved. There were significant increases in perceived happiness at rest (p = 0.006) and with smile (p = 0.002). Clinician grading revealed improved nasolabial fold depth at rest (p = 0.087) after surgery, and patients reported improved facial function and happiness with the decision to undergo surgery.

Conclusion

Intermediate follow-up suggests SD can improve objective resting and smile symmetry in patients with NFFP. After surgery, patients' faces convey more happiness in repose and with smile.