Transauricular facial nerve combing for post-paralytic synkinesis and tightness: a propensity score-matched study

OBJECTIVE: Refractory post-paralytic facial synkinesis and tightness pose a therapeutic challenge. This study aimed to assess the effectiveness and safety of transauricular facial nerve combing dissection in reducing synkinesis and tightness due to facial paralysis sequelae through retrospective propensity score-matched(PSM) cohort analysis. METHODS: The clinical data of 30 patients with sequelae of facial paralysis who underwent auricular nerve combing in the Department of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital from January 2019 to December 2023 were retrospectively analyzed. The main outcome measures were the scores of the combined Movement Assessment questionnaire (SAQ) and the visual analogue scale (VAS) of facial tightness. Secondary assessments included the House-Brackmann facial nerve function grade, Sunnybrook facial nerve score, and the Patient-reported outcome scale (FaCE). The outcome indicators and adverse events were compared between the two groups before treatment and at 6, 12 and 18 months after treatment. RESULTS: After propensity score-matching (PSM), baseline characteristics were balanced (P > 0.05). At 18 months, the study group showed significantly greater improvements than the control group in SAQ score (13.9 ± 3.7 vs. 30.7 ± 5.0, P < 0.001), VAS score (2.0 ± 0.7 vs. 6.1 ± 1.4, P < 0.001), H-B grade, Sunnybrook score, and FaCE score (all P < 0.05). Adverse events in the study group were minor and transient (e.g., retroauricular numbness, swelling). No serious adverse events occurred. CONCLUSION: Transauricular nerve combing provides durable improvements in synkinesis, tightness, facial function, and quality of life for refractory facial paralysis, with a satisfactory safety profile. SIGNIFICANCE & INNOVATION: This retrospective, propensity score-matched cohort study comprehensively assessed transauricular facial nerve combing dissection for facial paralysis sequelae. Results demonstrated significant, sustained benefits in alleviating synkinesis and tightness, restoring neurological function, and enhancing quality of life, providing robust evidence for clinical application.