{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T20:48:05Z","timestamp":1782506885965,"version":"3.54.5"},"reference-count":39,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Facial Plastic Surgery &amp; Aesthetic Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>While selective neurectomy has emerged as a surgical adjunct for patients with facial synkinesis to eliminate aberrantly regenerated axons, postoperative outcomes have been mixed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To understand how a zonal denervation approach to selective neurectomy targeting a broader elimination of unwanted neural elements can affect periocular and perioral movements among patients with facial synkinesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively assessed patients who underwent zonal denervation from July 2023 through August 2024. Pre- and postoperative photographs were analyzed in a blinded fashion using Emotrics and eFACE; postoperative changes were compared within patients using Wilcoxon matched-pairs signed rank tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We included 20 zonal denervation patients who were primarily female (90%) with median age of 51 years (interquartile range 42\u201363) and most often developed initial facial paralysis due to viral etiology (45%). These patients experienced significant improvement in median oral commissure excursion from 2.50 mm to 5.88 mm (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001) at median 12-month follow-up (interquartile range 9\u201314 months). Median interlabial distance difference decreased from 5.23 mm to 2.64 mm (\n                      <jats:italic toggle=\"yes\">p =<\/jats:italic>\n                      0.002), while median palpebral fissure width difference decreased from 2.98 mm to 1.01 mm (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.003). eFACE outcomes mirrored Emotrics improvements. Six patients (30%) developed transient oral incompetence resolving in less than 6 months in all cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Zonal denervation is an effective technique to improve periocular and perioral synkinesis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/26893614261460280","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:59:20Z","timestamp":1782284360000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Zonal Denervation Approach to Surgical Management of Facial Synkinesis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4459-0746","authenticated-orcid":false,"given":"Roy","family":"Xiao","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth R.","family":"McGonagle","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA."},{"name":"Hadlock Center for Facial Plastic Surgery, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine F.","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA."},{"name":"Hadlock Center for Facial Plastic Surgery, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa A.","family":"Hadlock","sequence":"additional","affiliation":[{"name":"Hadlock Center for Facial Plastic Surgery, Boston, Massachusetts, USA."},{"name":"Harvard Medical School, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2016.1462"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27481"},{"key":"e_1_3_2_4_1","volume-title":"Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center","author":"Hohman MH","year":"2014","unstructured":"3.Hohman MH, , Hadlock TA. 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