Combining early lower eyelid surgery with neuromuscular retraining for synkinesis prevention after facial palsy: the role of the eye in aberrant facial nerve regeneration

Arianna Di Stadio; Massimo Ralli; Pietro De Luca; Jake Sossamon; Teresa C Frohman; Marta Altieri; Ignazio La Mantia; Salvatore Ferlito; Elliot M Frohman; Michael J Brenner

doi:10.3389/fneur.2024.1443591

Combining early lower eyelid surgery with neuromuscular retraining for synkinesis prevention after facial palsy: the role of the eye in aberrant facial nerve regeneration

Front Neurol. 2024 Sep 18:15:1443591. doi: 10.3389/fneur.2024.1443591. eCollection 2024.

Authors

Affiliations

¹ Otolaryngology Unit, Department GF Ingrassia, University of Catania, Catania, Italy.
² Organ of Sense Department, University La Sapienza, Rome, Italy.
³ Otolaryngology Department, Fatebenefratelli-Isola Hospital, Rome, Italy.
⁴ Medical University of South Carolina, Charleston, SC, United States.
⁵ Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman, Stanford University School of Medicine, Palo Alto, CA, United States.
⁶ Neurology Department, University La Sapienza, Rome, Italy.
⁷ Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, United States.

Abstract

Background: Facial synkinesis (FS) is a distressing sequela of facial palsy (FP) characterized by involuntary, simultaneous movements of facial muscles occurring during voluntary facial expressions. Treatment of synkinesis is challenging, and preventive methods are needed.

Aim: This study evaluated the efficacy of physical facial nerve rehabilitation (PFNR) therapy alone vs. PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis.

Methods: Twenty five outpatients were randomized to receive either PFNR alone (neuromuscular retraining and Kabat proprioceptive neuromuscular facilitation) or PNFR and early (90 days after FP onset) eyelid surgery (involving a conservative oculoplastic correction for lagophthalmos with epiphora or ectropion). Comprehensive otolaryngological assessments and Magnetic Resonance Imaging (MRI) were conducted. Synkinesis progression was measured using Another Disease Scale (ADS) at baseline, 3-, 6-, 12-, and 24-months post-treatment. The data were analyzed with ANOVA, τ-test, Chi-Square analyses.

Results: Patients undergoing eyelid surgery with PFNR showed faster (p < 0.001) and better recovery of facial movements (p < 0.05) than patients receiving PFNR alone comparing T0 and T12 (p < 0.0001). No synkinesis were observed in the PFNR plus surgery group while 37% of patients in PFNR alone had synkinesis (p = 0.03). At 24 months, none of the patients in the surgery group presented synkinesis.

Conclusion: Combining early surgical treatment of paralytic lagophthalmos or epiphora with PFNR accelerated functional recovery and reduced synkinesis in patients with FP compared to facial rehabilitation alone. Further investigations in larger populations with long-term follow-up are needed.

Clinical trial registration: https://clinicaltrials.gov/study/NCT06538103, NCT06538103.

Keywords: aberrant facial reinnervation syndrome; facial paralysis; lagophthalmos; oculoplastic surgery; paralytic ectropion; synkinesis.

Associated data

ClinicalTrials.gov/NCT06538103

Grants and funding

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.