Summary
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: April 09, 2012
Accepted:
March 8,
2012
Received:
March 2,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
