SYSTEMATIC REVIEW article
Front. Ophthalmol.
Sec. Oculoplastics, Orbit and Trauma
This article is part of the Research TopicFacial Nerve Disease and its Impact on the Eye: Pathogenesis, Diagnosis, and Treatment.View all articles
Periocular Neurotization: A Systematic Review of Techniques and Outcomes in Orbicularis Oculi Reinnervation
Provisionally accepted
- Dalhousie University Faculty of Medicine, Halifax, Canada
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Background: Periocular neurotization is a surgical approach that can be indicated for the restoration of dynamic eyelid functions in patients with facial nerve palsy. The orbicularis oculi muscle, responsible for eyelid closure, can be the target of a variety of re-innervation techniques, such as direct nerve transfers and muscle transpositions. This systematic review aims to map the existing evidence on direct neurotization techniques of the OOM, including nerve grafting, nerve transfers, and contralateral muscle transposition, and to describe their published effectiveness. Methods: A systematic search of PubMed, Embase, and supplemental searching with citation chaining using google scholar to identify studies detailing periocular neurotization techniques. Studies were included if they reported clear outcomes such as restored blinking or eye closure, improved corneal protection, and enhanced eyelid symmetry. Results: Of 857 screened studies, 6 met inclusion criteria, comprising 4 cohort studies, 1 case series, and 1 case report, with 106 patients eligible for detailed extraction. Direct neurotization of the OOM was associated with improvements in eye closure, blink reflex, and electromyographic data. Motor donor nerve selection was noted to affect outcomes significantly, with contralateral facial nerve branches yielding the highest blink improvement. Conclusions: This review highlights the emerging role of direct neurotization techniques in reinnervating the orbicularis oculi muscle for appropriate patients with facial nerve palsy. Future high-quality studies are needed to establish clear indications, long-term efficacy, and comparative advantages of direct OOM neurotization in clinical practice.
Keywords: Orbicularis oculi1, blink restoration2, Nerve transfer3, Neurotization4, Muscle transposition5, facial reinnervation6
Received: 17 Aug 2025; Accepted: 06 Nov 2025.
Copyright: © 2025 Abu Osba, Abdullah, Oyesode and Hussain. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ahsen Hussain, ahsen@dal.ca
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