title: Botulinum toxin in the management of facial paralysis.
abstract: OBJECTIVE
  Complete flaccid facial paralysis, as well as the synkinetic and hyperkinetic sequelae of partial recovery, has significant impact on quality of life. Patients suffer from functional deficiencies, cosmetic deformity, discomfort and social consequences leading to emotional distress. Despite an extensive and sophisticated array of available interventions for facial reanimation, most patients have persistent issues that require consistent follow-up. In long-term management, botulinum toxin (BT) injection remains a critical tool in the treatment of the facial paralysis patient, particularly in the case of synkinesis, hyperkinesis and imbalance. We review the recent scientific literature and highlight key principles and developments in the use of BT in the management of facial paralysis, including less common applications for acute facial paralysis, hyperlacrimation and pseudoptosis.
  
  
  RESULTS
  We reviewed the literature for the latest advances in the use of BT in facial paralysis, including applications and technique, as well as measurement tools and adjunct exercises. We also share our experience in treating our own patient population.
  
  
  CONCLUSIONS
  BT continues to be a well tolerated and effective tool in the long-term management of facial paralysis, specifically in treating synkinesis, imbalance and hyperkinesis, as well as hyperlacrimation and pseudoptosis. Consistent measurement tools and adjunct neuromuscular retraining are crucial in the successful deployment of BT. Controversy exists as to whether BT should be used to manage facial paralysis during the acute phase, and whether BT application to the nonparalyzed face can improve long-term recovery in the paralyzed side.
authors.affiliation: aDepartment of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York bOphthalmic Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles cBeverly Hills Ophthalmic Plastic and Reconstructive Surgery dThe Facial Paralysis Institute, Beverly Hills eDepartment of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles fCenter for Advanced Facial Plastic Surgery, Beverly Hills, California, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Cabin
authors.forename: Guy G
authors.initials: GG
authors.lastname: Massry
authors.forename: Babak
authors.initials: B
authors.lastname: Azizzadeh
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D019468:Disease Management; D005158:Facial Paralysis / Q000188:drug therapy*; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011788:Quality of Life; D020127:Recovery of Function
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A