title: Botulinum toxin treatment for facial palsy: A systematic review.
abstract: BACKGROUND
  Facial palsy may be complicated by ipsilateral synkinesis or contralateral hyperkinesis. Botulinum toxin is increasingly used in the management of facial palsy; however, the optimum dose, treatment interval, adjunct therapy and performance as compared with alternative treatments have not been well established. This study aimed to systematically review the evidence for the use of botulinum toxin in facial palsy.
  
  
  METHODS
  The Cochrane central register of controlled trials (CENTRAL), MEDLINE(R) (1946 to September 2015) and Embase Classic + Embase (1947 to September 2015) were searched for randomised studies using botulinum toxin in facial palsy.
  
  
  RESULTS
  Forty-seven studies were identified, and three included. Their physical and patient-reported outcomes are described, and observations and cautions are discussed.
  
  
  CONCLUSIONS
  Facial asymmetry has a strong correlation to subjective domains such as impairment in social interaction and perception of self-image and appearance. Botulinum toxin injections represent a minimally invasive technique that is helpful in restoring facial symmetry at rest and during movement in chronic, and potentially acute, facial palsy. Botulinum toxin in combination with physical therapy may be particularly helpful. Currently, there is a paucity of data; areas for further research are suggested. A strong body of evidence may allow botulinum toxin treatment to be nationally standardised and recommended in the management of facial palsy.
authors.affiliation: Plastic Surgery Department, Queen Victoria Hospital, Holtye Rd, East Grinstead, RH19 3DZ, UK. Electronic address: lillicooper@doctors.org.uk.
authors.forename: Lilli
authors.initials: L
authors.lastname: Cooper
authors.affiliation: Year 12, Brighton College, Eastern Rd, Brighton, BN2 0AL, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Lui
authors.affiliation: Plastic Surgery Department, Queen Victoria Hospital, Holtye Rd, East Grinstead, RH19 3DZ, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Nduka
mesh_terms: D001905:Botulinum Toxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005146:Facial Asymmetry / Q000188:drug therapy; D005158:Facial Paralysis / Q000188:drug therapy*; D006801:Humans; D007273:Injections, Intramuscular; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D009465:Neuromuscular Agents; D001905:Botulinum Toxins
keywords: Botulinum toxin; Facial palsy; Neuromuscular retraining therapy; Synkinesis