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While patients with Bell’s Palsy usually make a complete recovery, about 30% of patients will develop chronic facial palsy and suffer from facial and neck tightness and synkinesis. Other conditions such as Ramsay Hunt Syndrome, acoustic neuroma resection, facial nerve repair, and trauma can also result in long-term facial tightness and synkinesis. This chronic facial paralysis results from abnormal facial nerve recovery.

What is selective denervation?

Selective denervation is a surgical procedure that can improve the smile, facial symmetry, and facial tightness in some patients with chronic facial paralysis. The procedure accomplishes this by mapping out all of the facial nerve branches, and then taking away the branches which innervate muscles restricting the smile, and branches causing synkinesis. 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 paralysis. At the UNC Facial Nerve Center, we will discuss this procedure with patients and help them decide whether it is right for them.

Patient with chronic facial paralysis
Figure: Patient with chronic facial paralysis before (left) and after (right) selective denervation surgery.

What to expect during selective denervation surgery:

Selective denervation is performed under general anesthesia. A facelift incision is performed on the affected side and at least 10-20 facial nerve branches are identified using intraoperative nerve stimulation. The facial movements associated with each nerve branch are carefully mapped out 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 good facial movements are preserved. Typically, patients will go home the same day or stay one night in the hospital. While improvements can be seen as soon as the first day after surgery, often times we will have patients work with our facial nerve therapist beginning a few weeks after surgery to optimize facial movements and symmetry.

Patient After Selective Denervation, face at restAfter Selective Denervation - UNC Facial Nerve Center Patient

before and after smile photo

If you would like to schedule a consultation at the UNC Facial Nerve Center, please call 984-974-2255 to schedule.