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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Neurorehabilitation
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1443591
This article is part of the Research Topic Craniofacial Neuroscience View all 11 articles

Combining Early Lower Eyelid Surgery with Neuromuscular Retraining for Synkinesis Prevention after Facial Palsy. The role of the eye in aberrant facial nerve regeneration

Provisionally accepted
Arianna Di Stadio Arianna Di Stadio 1,2*Massimo Ralli Massimo Ralli 3Pietro De Luca Pietro De Luca 4Jake sossamon Jake sossamon 5Teresa C. Frohman Teresa C. Frohman 6Marta Altieri Marta Altieri 7Ignazio La Mantia Ignazio La Mantia 1Salvatore Ferlito Salvatore Ferlito 1Elliot M. Frohman Elliot M. Frohman 6Michael J. Brenner Michael J. Brenner 8
  • 1 Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Sicily, Italy
  • 2 Santa Lucia Foundation (IRCCS), Rome, Lazio, Italy
  • 3 Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
  • 4 Ospedale San Pietro Fatebenefratelli, Rome, Lazio, Italy
  • 5 MUSC Health, Charleston, South Carolina, United States
  • 6 Stanford University, Stanford, California, United States
  • 7 Sapienza University of Rome, Rome, Lazio, Italy
  • 8 University of Michigan, Ann Arbor, Michigan, United States

The final, formatted version of the article will be published soon.

    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 versus PNFR with eyelid surgery to correct lagophthalmos and prevent the onset of synkinesis.Methods: 25 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, t-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.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.

    Keywords: Facial Paralysis, Synkinesis, Paralytic ectropion, lagophthalmos, oculoplastic surgery, aberrant facial reinnervation syndrome ha formattato: Inglese americano

    Received: 04 Jun 2024; Accepted: 06 Sep 2024.

    Copyright: © 2024 Di Stadio, Ralli, De Luca, sossamon, Frohman, Altieri, La Mantia, Ferlito, Frohman and Brenner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Arianna Di Stadio, Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Sicily, Italy

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.