Selective Orbicularis Neuromyectomy: A Reliable Treatment for Periocular Synkinesis

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Objectives: Selective orbicularis neuromyectomy for postparetic periocular synkinesis was first reported in 2015. This study aims to statistically evaluate the accumulated outcomes and stability of this treatment.

Methods: Twenty-five patients with postparetic periocular synkinesis were treated with this procedure between March 2010 and February 2020. Every patient was evaluated using the Sunnybrook scale, and their palpebral fissure width was measured using preoperative and postoperative videos. Patients who underwent >1-year follow-up were included in the study. Chemodenervation or physical therapy was not performed during the follow-up periods.

Results: Of the 25 patients, 20 were included in this study. The follow-up period was 13-96 months (median 32 months). The mean of the patients' synkinesis scores fell by 4.6 points. Palpebral fissure width while puckering and at rest was significantly different between the preoperative and postoperative measurements (p < 0.01). Lower lid drooping gradually deteriorated in one patient 7 years after the treatment and was corrected secondarily.

Conclusions: This study demonstrates that selective orbicularis neuromyectomy is a simple and sustainable treatment for periocular synkinesis. However, further longer follow-up of elderly patients and objective analysis are warranted.