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Home/Facial Procedures/Facial Palsy & Paralysis Reconstruction/Selective Neurectomy

Selective neurectomy is a specialised procedure developed to help patients with loss of facial movement, synkinesis, and tightness following an episode of facial palsy. It may be beneficial to any patient who has experienced only a partial recovery after suffering a complete facial weakness caused by complications such as Bell’s palsy or Ramsay Hunt Syndrome. The surgery, which is also referred to as “selective neurolysis” and “neuromyectomy,” can address the nerve misfirings that cause patients with synkinesis to suffer involuntary facial movements and muscle contractions.

When performed by a facial reconstruction expert such as our Oxford-educated Consultant Plastic Surgeon, Mr William Townley, selective neurectomy may allow patients to smile more easily and reduce a great deal of their discomfort.

The mechanism involves suppressing antagonistic movements by abnormal nerve branches (causing twitches and tightness) and thereby enabling natural movements such as smiling to flourish. Mr Townley has pioneered a special modification to the procedure that also aims to augment the smile movements further by rerouting rather than just dividing these abnormal nerve branches – selective neuroaugmentation.

What Are the Benefits of Selective Neurectomy?

Potential benefits of selective neurectomy include:

Patients with less pronounced synkinesis may be better suited for botulinum toxin injections, which can prohibit unwanted muscle contractions on a smaller scale. Alternatively, if you are interested in a more comprehensive facial rejuvenation, Mr Townley is often able to combine selective neurectomy with facelift surgery.

How Is Selective Neurectomy Performed?

A highly nuanced procedure, selective neurectomy should be performed only by a Consultant Plastic Surgeon with decades of experience and a special interest in facial palsy surgery.

All patients are given a trial of botulinum toxin prior to surgery to target the antagonistic muscles and ensure that a positive response is observed before progressing to selective neurectomy. If the injections are unhelpful, surgery is unlikely to be beneficial.

The surgery is typically performed under general anaesthesia and, due to its complexity, can sometimes take several hours. A facelift-type incision is used, as is a deep plane approach, to access the facial nerve branches. While the precise course of surgery can vary based on the patient’s unique symptoms and medical needs, the procedure generally involves the mapping of different nerve branches using sophisticated nerve monitoring equipment and then division of misfiring facial nerves that are causing antagonistic movements.

The target muscles are often the depressors (e.g. platysma in the neck, buccinator, depressor anguli oris) but may include eye and lip muscles too. Mr Townley will employ advanced, proven surgical methods to identify the problematic nerves and divide them. With the newly pioneered technique, some abnormal branches are meticulously re-wired under a microscope rather than just divided. This method can augment favourable movements, such as smiling.

What Does Recovery After Selective Neurectomy Entail?

Following your selective neurectomy, you will likely have to remain in hospital overnight. Swelling and bruising are to be expected for a few weeks, but these effects can typically be controlled with pain relief medication.

Mr Townley will require you to attend follow-up appointments, wherein your recovery and progress will be closely monitored. Sutures are removed at one week and the social downtime is two to three weeks. The results of the surgery should appear gradually in the following months, provided you adhere to your aftercare instructions. This is still a relatively experimental procedure, and the precise indications are still being determined. Not every patient with post paresis syndrome benefits from selective neurectomy, therefore a balanced discussion and careful assessment is required before considering surgery.

As a leading clinician in the Facial Nerve Centre at Guy’s and St. Thomas’, Mr William Townley is proficient in various types of facial reconstruction surgery. If you are suffering from synkinesis and are keen to explore the possibility of smiling more easily, please feel free to schedule a consultation at our London practice.

Medical References

Stanford Medicine

Loyola Medicine

Facial Palsy UK