title: Therapeutic strategies in post-facial paralysis synkinesis in pediatric patients.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: International Institute of Reconstructive Microsurgery, 27-28 Thomson Ave, Suite 620, Long Island City, NY 11101, USA. jktmd1@aol.com
authors.forename: Julia K
authors.initials: JK
authors.lastname: Terzis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karypidis
mesh_terms: D000293:Adolescent; D001676:Biofeedback, Psychology; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005149:Facial Expression; D005152:Facial Muscles / Q000503:physiopathology / Q000601:surgery; D005154:Facial Nerve / Q000503:physiopathology / Q000637:transplantation*; D005158:Facial Paralysis / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards; D026741:Physical Therapy Modalities / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D046608:Synkinesis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A