title: Mirror biofeedback rehabilitation after administration of single-dose botulinum toxin for treatment of facial synkinesis.
abstract: OBJECTIVE
  The efficacy of facial biofeedback rehabilitation with a mirror after administration of a single dose of botulinum A toxin on facial synkinesis was examined in patients with chronic facial palsy.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  The present study includes 8 patients with Bell palsy and 5 with herpes zoster oticus showing facial synkinesis. A single dose of botulinum A toxin was used as the initial process of facial rehabilitation. Patients then continued a daily facial biofeedback rehabilitation with a mirror at home. They were instructed to keep their eyes symmetrically open using a mirror during mouth movements. The degree of oral-ocular synkinesis was evaluated by the degree of asymmetry of eye opening width during mouth movements (% eye opening).
  
  
  RESULTS
  After administration of a single dose of botulinum A toxin, temporary relief of facial synkinesis was observed in all patients. Patients were then instructed to continue the facial biofeedback rehabilitation with a mirror for 10 months. The mean values of the percent of eye opening during 3 designated mouth movements that included lip pursing /u:/, teeth baring /i:/, and cheek puffing /pu:/ increased significantly after 10 months when the effects of botulinum A toxin had completely disappeared.
  
  
  CONCLUSIONS
  These findings demonstrate that facial biofeedback rehabilitation with a mirror after administration of a single dose of botulinum A toxin is a long-lasting treatment of established facial synkinesis in patients with chronic facial palsy.
authors.affiliation: Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan. otazjp@clin.med.tokushima-u.ac.jp
authors.forename: Takahiro
authors.initials: T
authors.lastname: Azuma
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Nakamura
authors.forename: Mika
authors.initials: M
authors.lastname: Takahashi
authors.forename: Seizo
authors.initials: S
authors.lastname: Ohyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Toda
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Bukasa
authors.initials: B
authors.lastname: Kalubi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Takeda
mesh_terms: D000328:Adult; D000368:Aged; D001676:Biofeedback, Psychology / Q000187:drug effects*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005145:Face; D005152:Facial Muscles / Q000503:physiopathology*; D005158:Facial Paralysis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000187:drug effects / Q000502:physiology*; D009465:Neuromuscular Agents / Q000008:administration & dosage; D011446:Prospective Studies; D046608:Synkinesis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A