Selective Neurectomy

Selective neurectomy is a surgical treatment for synkinesis.  Synkinesis describes the “cross wiring” that can occur after Bell’s palsy or other reversible forms of facial paralysis.  In synkinesis, the muscles of the face contract unintentionally.  Most commonly, patients may notice forceful eye closure when they attempt to smile, or other unintentional muscle spasms during routine facial movements. It is essentially a “faulty re-wiring” of the facial nerve that occurs after injury and recovery. 

At the Stanford Facial Nerve Center, synkinesis management begins with an assessment with Dr. Pepper.  Patients will then undergo a course of specialized therapy called Facial Neuromuscular Retraining with our specialized Rehabilitation specialist, Sarah Stranberg, SLP.  For some patients, botulinum toxin is then used to temporarily paralyze the muscles that are contracting incorrectly. For the majority of patients with synkinesis, facial retraining with or without botulinum toxin achieves their treatment goals.   

Some patients may continue to have difficulty despite effective facial retraining and rehabilitation.  For these patients, Botulinum toxin (also known as Botox™ or other similar medications) can be used to also guide which muscles of the face can be safely permanently “turned off” through Selective neurectomy (nerve cutting) and myectomy (muscle cutting).  For example, if botulinum toxin injected into the platysma muscle (neck muscle) improves smile and facial symmetry, then the nerve branch and muscle of the platysma can be cut during a facelift-type surgery in order to offer more permanent improvement.

The video shows a patient discussing her selective neurectomy and myectomy procedure.

In general, most patients with synkinesis do not require any surgical treatment.  Selective neurectomy is reserved for patients who do not respond to rehabilitation therapy and who have a favorable response to botulinum toxin in the muscles around the lower lip and neck.

The procedure is performed through facelift-type incisions and can be combined with a facelift on the opposite side of the face.  The surgery is usually either outpatient (return home the same day as surgery) or is followed by an overnight stay in the hospital with return home the following morning.  Swelling and bruising from the procedure takes about 3 weeks to resolve.