A Comparative Study of Platysmal Myoneurectomy With Variations of Selective Neurectomies in Post‐Facial Palsy Synkinesis

ABSTRACT Synkinesis is a distressing sequela of facial palsy. The main treatment for this condition has been Botulinum toxin injections. However, more recently, selective neurolysis/neurectomies have shown promise, with some variations in practice evolving over time. A clinical review of practice was performed on sixty‐eight patients ( n = 68) with Bell's palsy over five years (2018–2023) who underwent synkinesis surgery, following facial palsy. Comparisons were made between platysmal myoneurectomy only (Group I), platysmal myoneurectomy and zygomaticus major/levator labii superior direct neurotization (Group II), platysmal myoneurectomy and depressor anguli oris (DAO) selective neurectomy (Group III) and platysmal myoneurectomy + DAO and buccinator selective neurectomies (Group IV). The following outcome measures were used: Sunnybrook Facial Grading Scale (FGS), Facial Clinimetric Evaluation (FaCE), Facial Disability Index (FDI), and Synkinesis Assessment Questionnaire (SAQ). Statistical analyses were performed using the student's t ‐test and ANOVA. There was an overall improvement for patients pre‐ and post‐operatively (42.34 ± 16.37 vs. 65.12 ± 14.34; Student's t ‐test, p < 0.0001). All FGS scores showed statistically significant ( p < 0.05) improvement. FDI‐physical, SAQ, and FaCE showed statistically significant improvements, apart from the FDI‐social ( p = 0.08). Qualitatively, all procedures showed significant improvement compared with their pre‐op state, with Group IV showing the best results among platysmal myoneurectomy variants in terms of repose, volitional movements, and synkinesis reduction compared with its contemporaries.