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Therapeutic Strategies in Post–Facial Paralysis Synkinesis in Adult Patients

Terzis, Julia K. M.D., Ph.D.; Karypidis, Dimitrios M.D.

Plastic and Reconstructive Surgery: June 2012 - Volume 129 - Issue 6 - p 925e–939e
doi: 10.1097/PRS.0b013e318230e758
Reconstructive: Head and Neck: Original Articles

Background: Facial synkinesis comprises unwanted facial muscle contractions in different facial muscle groups following voluntary ones, in cases of incomplete recovery from facial paralysis. Facial expressivity and function are impaired, and the psychological integrity of the patients is seriously affected.

Methods: Thirty-one adult patients (older than 18 years) presenting with post–facial paralysis synkinesis were included in this study. The mean patient age was 39.6 years and the mean denervation time was 124 months.

Results: There were five patient groups. Group A (n = 9) underwent cross-facial nerve grafting and secondary microcoaptations. Group B (n = 8) had cross-facial nerve grafting, secondary microcoaptations, and botulinum toxin type A injections. Group C (n = 6) received cross-facial nerve grafting, secondary microcoaptations, botulinum toxin type A, and selective neurectomies. Group D (n = 2) underwent cross-facial nerve grafting, direct muscle neurotization, and botulinum toxin type A. Group E underwent other means of treating synkinesis (n = 6), such as botulinum injections alone (n = 1), biofeedback alone (n = 2), biofeedback with selective neurectomies and myectomies (n = 2), and biofeedback and botulinum injections (n = 1). Group B had the highest synkinesis improvement (100 percent), followed by groups A and C (66 percent). Functional results were improved, with smile improvement being higher in group C and eye closure being higher in groups A, B, and E.

Conclusion: Meticulous patient selection and evaluation followed by an individualized form of treatment, most frequently including cross-facial nerve grafting and secondary microcoaptations along with botulinum toxin type A and biofeedback including facial muscle retraining, constitute an effective and reliable methodology with which to combat post–facial paralysis synkinesis.



Norfolk, Va.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Microsurgery Program, Eastern Virginia Medical School.

Received for publication March 9, 2011; accepted May 11, 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Julia K. Terzis, M.D., Ph.D.; Department of Plastic and Reconstructive Surgery, New York University Medical Center, International Institute of Reconstructive Microsurgery, 27-28 Thomson Avenue, Suite 620, Long Island City, N.Y. 11101,

©2012American Society of Plastic Surgeons