Therapeutic strategies in post-facial paralysis synkinesis in adult patients.
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.


CONCLUSIONS
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.


METHODS
Therapeutic, IV.
Norfolk, Va. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Microsurgery Program, Eastern Virginia Medical School.
Julia K
JK
Terzis
Dimitrios
D
Karypidis
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005149:Facial Expression; D005152:Facial Muscles / Q000294:innervation / Q000503:physiopathology; D005154:Facial Nerve / Q000637:transplantation*; D005158:Facial Paralysis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D046608:Synkinesis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A