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Facial Reanimation Procedures are Associated with Reduced Mental Health Disorders in Patients with Facial Paralysis
Jeffrey Khong
*, Rachana Suresh, John Nguyen, Zachary Zamore, Mohammed Shahid, Jared Zhang, Alec Chen, Miriam Vicente Ruiz, Sami Tuffaha
Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
Background: Patients with facial paralysis experience significant functional and social challenges, often leading to psychosocial distress. While facial reanimation procedures aim to restore symmetry and function, their associations with mental health outcomes are underexplored. We aimed to investigate the impact of facial reanimation procedures on new-onset depression and anxiety in patients with facial paralysis.
Methods: We conducted a retrospective cohort study using the TriNetX database (2016-present) of patients with facial paralysis. Patients were grouped based on whether they underwent facial reanimation procedures (static: sling-based; dynamic: nerve- or free flap-based; none). Patients with prior depression or anxiety disorders were excluded. Baseline demographics including age, gender, and synkinesis diagnoses were collected, and 1:1 propensity score matching was applied to balance cohorts. Risk ratios compared two-year rates of new-onset depression, anxiety, and mental health-related prescriptions (SSRIs, TCAs, MAOIs) at the significance level α = 0.05.
Results: We identified a total of 171,174 patients with facial paralysis, with 4,749 undergoing facial reanimation and 166,425 receiving no treatment. After matching, 4,532 patients remained in each cohort with similar demographic profiles. Patients undergoing any facial reanimation procedure demonstrated a 32% lower risk of new-onset depression (RR: 0.68, 95% CI: [0.53, 0.89], p<0.01) and a 26% lower risk of anxiety (RR: 0.74, 95% CI: [0.59, 0.92], p<0.01) compared to untreated patients. Rates of new mental health prescriptions were similar between groups. Patients undergoing static versus dynamic reanimation procedures had similar risks of new-onset depression, anxiety, and mental health prescriptions.
Conclusions: Facial reanimation procedures are associated with significantly reduced rates of new-onset depression and anxiety among patients with facial paralysis. These findings underscore the potential mental health benefits of surgical intervention and support its consideration for affected patients.
Table 1. Patient characteristics, new diagnoses of mental health disorders, and prescriptions of mental health medications in patients with facial paralysis treated with facial reanimation procedures compared to untreated patients, after matching.
| | Facial Paralysis Treated with Reanimation Procedures
(n = 4,532) | Untreated Facial Paralysis
(n = 4,532) | Risk Ratio
(95% CI) | p-value |
| Baseline Characteristics | | | | |
| Age | 62.3 (17.2) | 62.6 (17.1) | | 0.479 |
| Female | 1,921 (42.4%) | 1,904 (42.0%) | | 0.718 |
| Male | 2,608 (56.5%) | 2,625 (57.9%) | | 0.718 |
| Blepharospasm | 80 (1.8%) | 62 (1.4%) | | 0.128 |
| Clonic hemifacial spasm | 209 (4.6%) | 220 (4.9%) | | 0.586 |
| Other abnormal involuntary movements | 112 (2.4%) | 97 (2.1%) | | 0.262 |
| Outcomes | | | | |
| Major depressive disorder | 97 (2.1%) | 141 (3.1%) | 0.69
(0.53, 0.89) | 0.004 |
| Generalized anxiety disorder | 125 (2.8% | 170 (3.8%) | 0.74
(0.59, 0.92) | 0.008 |
Mental health prescriptions
(SSRIs, TCAs, MAOIs) | 644 (14.2%) | 618 (13.4%) | 1.04
(0.94, 1.15) | 1.042 |
SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant; MAOI = monoamine oxidase inhibitor
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