Myectomies for Optimization of Function and Symmetry in Facial Paralysis

Myectomy, the surgical excision of a portion of the muscle, is a useful adjunct in the treatment of facial paralysis and its sequelae. Targeting the facial muscles specifically can address aesthetic and functional concerns for patients. It is a straightforward surgical option for the surgeon and may be used to optimize symmetry, release hypercontracture and limit synkinesis. Prior to myectomy, chemodenervation with botulinum toxin can be used to assess and confirm target muscles. If limited to the affected muscle or muscle groups, the procedure is low risk for creating further facial dysfunction and may provide significant benefit to a correctly-selected patient. In this chapter, we discuss the different muscle groups targeted with specific goals, common myectomy procedures, and considerations in treatment.