A Comparative Study of Platysmal Myoneurectomy With Variations of Selective Neurectomies in Post-Facial Palsy Synkinesis

Synkinesis is a distressing sequela of facial palsy. The main treatment for this condition has been Botulinum toxin injections. However, more recently, selective neurolysis/neurectomies have shown promise, with some variations in practice evolving over time. A clinical review of practice was performed on sixty-eight patients (n = 68) with Bell's palsy over five years (2018–2023) who underwent synkinesis surgery, following facial palsy. Comparisons were made between platysmal myoneurectomy only (Group I), platysmal myoneurectomy and zygomaticus major/levator labii superior direct neurotization (Group II), platysmal myoneurectomy and depressor anguli oris (DAO) selective neurectomy (Group III) and platysmal myoneurectomy + DAO and buccinator selective neurectomies (Group IV). The following outcome measures were used: Sunnybrook Facial Grading Scale (FGS), Facial Clinimetric Evaluation (FaCE), Facial Disability Index (FDI), and Synkinesis Assessment Questionnaire (SAQ). Statistical analyses were performed using the student's t-test and ANOVA. There was an overall improvement for patients pre- and post-operatively (42.34 ± 16.37 vs. 65.12 ± 14.34; Student's t-test, p < 0.0001). All FGS scores showed statistically significant (p < 0.05) improvement. FDI-physical, SAQ, and FaCE showed statistically significant improvements, apart from the FDI-social (p = 0.08). Qualitatively, all procedures showed significant improvement compared with their pre-op state, with Group IV showing the best results among platysmal myoneurectomy variants in terms of repose, volitional movements, and synkinesis reduction compared with its contemporaries.