Synkinetic movements comprise abnormal involuntary contractions of one or more facial muscle groups which follow the desired contraction of another facial muscle group. They are frequently encountered in patients with long standing facial paralysis and seriously affect their psychological status due to the impairment of their facial appearance, function and emotional expressivity.
Patients and methods
Eleven pediatric patients (2 male and 9 female) presenting with post-facial paralysis synkinesis were included in the study. Mean age was 10.3 ± 4 years and mean denervation time 72.5 months.
Patients underwent the following types of treatment:
- Cross facial nerve grafting (CFNG) and secondary microcoaptations with botulinum toxin injection which had an improvement of 100% (3 in the 3 grade synkinesis scale) (n = 2).
- Cross facial nerve grafting (CFNG) and secondary microcoaptations without botulinum toxin injection which had an improvement of 66%(2 in the 3 grade synkinesis scale) (n = 5).
- CFNG and direct muscle neurotization with (n = 2) or without (n = 1) botulinum toxin injection where the improvement was 33%.
- Contralateral nasalis muscle myectomy was performed in one patient along with CFNG and secondary microcoaptations which resulted in 66% synkinesis improvement. Biofeedback was invariably undertaken by all patients. Postoperative improvement in eye closure and smile was also noted in the respective cases treated for synkinesis ranging from 25 to 50%, with all patients achieving optimum functional return.
CFNG with secondary microcoaptations and botulinum toxin injections was found to be a very efficient surgical modality addressing post-facial palsy synkinesis with high improvement in facial function and symmetry. Facial neuromuscular re-education contributes considerably in the treatment.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The surgical management of facial nerve injury.Semin Plast Surg. 2004 Feb; 18: 23-30
- Mechanisms of synkinesis.Laryngoscope. 1979 Nov; 89: 1847-1854
- Automated facial image analysis: detecting improvement in abnormal facial movement after treatment with botulinum toxin A.Ann Plast Surg. 2007 Jan; 58: 39-47
- Patterns of facial nerve synkinesis.Laryngoscope. 1996 Dec; 106: 1491-1496
- The problem of synkinesis and contracture in cases of hemifacial spasm and Bell's palsy.Ann Otol Rhinol Laryngol. 1952 Sep; 61: 850-872
- Electrophysiologic analysis of aberrant regeneration after facial nerve paralysis.Neurology. 1975 Oct; 25: 989-993
- Hemifacial spasm: clinical and electrophysiologic observations.Neurology. 1979 Sep; 29: 1261-1272
- Excitability of facial nucleus and related brain-stem reflexes in hemifacial spasm, post-facial palsy synkinesis and facial myokymia.Clin Neurophysiol. 2005 Jul; 116: 1542-1554
- Hemifacial spasm and the facial nucleus.Ann Neurol. 1978 Aug; 4: 97-103
- Monitoring facial EMG responses during microvascular decompression operations for hemifacial spasm.J Neurosurg. 1987 May; 66: 681-685
- Movement disorders in patients with peripheral facial palsy.Mov Disord. 2003 Dec; 18: 1424-1435
- Aberrant facial nerve regeneration (AFR): an under-recognized cause of ptosis.Eye (Lond). 2004 Feb; 18: 159-162
- Axonal misdirection as contributing factor to aberrant reinnervation of muscles after facial nerve suture in cats.Arch Physiol Biochem. 2003 Jul; 111: 273-283
- After facial nerve damage, regenerating axons become aberrant throughout the length of the nerve and not only at the site of the lesion: an experimental study.Br J Neurosurg. 2004 Feb; 18: 45-48
- Rodent facial nerve recovery after selected lesions and repair techniques.Plast Reconstr Surg. 2010 Jan; 125: 99-109
- Blink restoration in adult facial paralysis.Plast Reconstr Surg. 2010 Jul; 126: 126-139
- Outcomes of direct muscle neurotization in pediatric patients with facial paralysis.Plast Reconstr Surg. 2009 Nov; 124: 1486-1498
- Sunnybrook facial grading system: reliability and criteria for grading.Laryngoscope. 2010 May; 120: 1038-1045
- Validation of the synkinesis assessment questionnaire.Laryngoscope. 2007 May; 117: 923-926
- Objective computerized versus subjective analysis of facial synkinesis.Laryngoscope. 2005 Dec; 115: 2118-2122
- Reliability of the “Sydney”, “Sunnybrook” and “House Brackmann” facial grading systems to assess voluntary movement and synkinesis after facial nerve paralysis.Otolaryngol Head Neck Surg. 2005 Apr; 132: 543-549
- Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function.Otol Neurotol. 2003 Jan; 24: 118-122
- Development of a sensitive clinical facial grading system.Otolaryngol Head Neck Surg. 1996 Mar; 114: 380-386
- Efficacy of feedback training in long-standing facial nerve paresis.Laryngoscope. 1991 Jul; 101: 744-750
- Management of synkinesis.Facial Plast Surg. 2008 May; 24: 242-249
- Orbicular synkinesis after facial paralysis: treatment with botulinum toxin.Doc Ophthalmol. 1994; 86: 395-402
- Evaluation and treatment of synkinesis with botulinum toxin following facial nerve palsy.Disabil Rehabil. 2010 Feb 15; ([Epub ahead of print])
- Botulinum A toxin for treatment of aberrant facial nerve regeneration.Plast Reconstr Surg. 1993 May; 91: 1042-1045
- Treatment of aberrant facial nerve regeneration with botulinum toxin A.Orbit. 2004 Dec; 23: 213-218
- Botulinum toxin in facial palsy: an effective treatment for contralateral hyperkinesis.Plast Reconstr Surg. 2007; 120: 917-927
- Low-dose subcutaneous injection of botulinum toxin type A for facial synkinesis and hyperlacrimation.Acta Neurol Scand. 2007; 115: 271-274
- Functional upgrading of partially recovered facial palsy by cross-face nerve grafting with distal end-to-side neurorrhaphy.Plast Reconstr Surg. 2006; 117: 597-608
Published online: April 09, 2012
Accepted: March 8, 2012
Received: March 2, 2011
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.