Selective Neurectomy & Myectomy Surgery

Selective neurectomy and myectomy are surgeries used to treat synkinesis and abnormal facial movement that may happen after facial nerve injury from facial paralysis.

Synkinesis happens when the facial nerve heals incompletely and muscles begin to move at the wrong time. For example, when you try to smile, your eye may narrow or your neck may tighten.

When physical therapy and Botox don’t help enough, surgery may help reduce unwanted muscle movement and improve facial symmetry.

How Selective Neurectomy Works

Selective neurectomy involves carefully identifying and modifying branches of the facial nerve that are causing abnormal movement.

During surgery, the surgeon maps the branches of the facial nerve using gentle electrical stimulation. This allows the surgical team to determine which nerves move the face in the wrong direction.

Nerve branches responsible for unwanted movements are divided to stop that movement, while branches responsible for important movements such as smiling and eye closure are preserved.

Selective Myectomy

In addition to modifying nerves, surgeons may also release or remove small portions of specific muscles that contribute to facial tightness or abnormal movement. This is called selective myectomy.

Muscles commonly treated include:

• The depressor anguli oris, which pulls the corner of the mouth downward
• The platysma muscle, which is responsible for bands in the neck
• The orbicularis oculi muscle around the eye, which causes squinting

Combining neurectomy and myectomy can reduce facial tightness and make facial movement more balanced.

Recovery & Results

Selective neurectomy and myectomy are usually done as outpatient procedures, so you can go home the same day. Many people notice improvement in facial tightness and unwanted movement soon after surgery.

Physical therapy is an important part of recovery and helps retrain your facial muscles to move more naturally.

Although surgery can significantly improve synkinesis, most patients still benefit from occasional Botox treatment to maintain optimal results.