Association of facial reanimation surgery on mental health outcomes in patients with facial paralysis.

OBJECTIVE

To evaluate differences in the prevalence of depression and anxiety between patients with facial paralysis who received facial reanimation surgeries or no treatment.

METHODS

This multicenter, retrospective cohort study utilized de-identified patient data from the TriNetX database from January 1, 2010 to December 31, 2025. Patients included were adults aged 18 years or older with a history of facial paralysis and no prior diagnosis of mental health disorders. Patients received any facial reanimation procedure including facial nerve repair, static procedures, or free tissue transfer. Subgroup analysis was conducted for each procedure category. All cohorts were compared to a control group consisting of patients who did not undergo any facial reanimation procedure. Depression and anxiety outcomes were reported as relative risks (RRs) with 95% confidence intervals (CIs) up to 5 years post-intervention.

RESULTS

Depression and anxiety were higher in patients who did not undergo any facial reanimation procedure to address facial paralysis (RR: 0.69[0.60-0.80]). Treatment specifically with facial nerve repair was associated with a lower rate of depression and anxiety (RR: 0.49[0.36-0.67]; 0.56[0.43-0.73]). Static procedures were also associated with lower rates of depression and anxiety (RR: 0.65[0.55-0.76]; 0.57[0.49-0.66]), while there were no differences for free tissue transfer (RR: 1.67[0.83-3.35]; 1.28[0.70-2.32]).

CONCLUSIONS

Facial reanimation surgery for facial paralysis, including facial nerve repair and static procedures, appears to be associated with lower rates of depression and anxiety.