title: Management of synkinesis and asymmetry in facial nerve palsy: a review article.
abstract: BACKGROUND
  The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy.
  
  
  METHODS
  Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013.
  
  
  RESULTS
  Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education.
  
  
  CONCLUSIONS
  Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.
authors.affiliation: Department of Physiotherapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Abbas Ali
authors.initials: AA
authors.lastname: Pourmomeny
authors.affiliation: Department of Physiotherapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Sahar
authors.initials: S
authors.lastname: Asadi
keywords: Bell's palsy; Electromyography biofeedback; Facial palsy; Physiotherapy; Synkinesis