Selective denervation is a surgical procedure that can improve smile, facial symmetry, synkinesis, and facial tightness in some patients with an extreme form of faulty and over-exuberant regeneration. During the procedure, all of the facial nerve branches are mapped out to see which muscles or muscle groups they control, and then the branches which innervate muscles opposing the smile and branches causing synkinesis are cut and eliminated. Selective denervation has the potential to restore a balanced and spontaneous smile in patients while relieving some of the facial tightness that affects so many patients with chronic facial palsy. At the Facial Nerve Center, we will discuss this procedure with patients and help them decide whether it is right for them.
Selective denervation is performed under general anesthesia. A facelift incision is performed on the affected side and approximately 10 facial nerve branches are identified using intraoperative nerve stimulation. The facial movement(s) associated with stimulation of each nerve branch is carefully observed, allowing the surgeon to decide which branches should be sacrificed to improve smile and facial symmetry. These branches are resected, while the nerve branches resulting in pleasing facial movement(s) are preserved. The incision is then closed and a small drain is placed. Typically, patients will stay one night in the hospital and then the drain will be removed prior to discharge the next morning. Patients will have stitches that will be removed 1-2 weeks after surgery. While improvements can be seen as soon as the first day after surgery, often we will have patients work with our facial nerve therapists beginning a few weeks after surgery to optimize facial movements and symmetry..