Surgical Management of Postparalysis Facial Palsy and Synkinesis.

Modified selective neurectomy of the distal branches of the buccal, zygomatic, and cervical branches of the facial nerve in addition to platysmal myotomy is an effective surgical procedure for the treatment of postfacial paralysis synkinesis. Success of this procedure depends on identification of the peripheral facial nerve branches, preservation of zygomatic and marginal mandibular branches that innervate key smile muscles, and ablation of buccal and cervical branches that cause lateral and/or inferior excursion of the oral commissure. Results are long-lasting; objective improvements in electronic clinician-graded facial function scale score, House-Brackmann score, and decreased botulinum toxin-A requirements have been observed.