Facial Synkinesis

Considerations

• • Definition

    • involuntary muscular movements accompanying voluntary movements

  • Spectrum of function

    • Flaccid <------> Normal

      • In the middle, non-flaccid facial paralysis, which is synkinesis

  • Etiology, multiple theories 

    • Unnatural regeneration 

    • Cross talk

    • Central processing 

  • Clinical evaluation

    • Repose

    • Repeatable movements 

  • Treatment options 

    • Observation <------> PT <------> Botox <------> Surgery 

      • PT

        • Goals

          • Maximize symmetry

          • Minimize chronic pain

        • Techniques

          • Stretching and strengthening 

          • Mime

          • Electrotherapy (TENS)

          • Biofeedback

      • Botox

        • Impact and role varies according to respective facial muscle group

        • Forehead 

        • Orbicularis oculi - pseudo-ptosis  

        • Midface 

        • Lower lip

        • Platysma 

      • Surgery

        • Consider after trying less invasive options 

        • Factor Both reanimation and de-animation 

        • Address both nerve and muscle 

          • Nerve

            • Selective neurectomy 

            • Cross-facial nerve grafting (CFNG)

            • Neurotization - implant nerve ending into muscle 

          • Muscle (re-positioning vs sectioning - "permanent Botox") 

            • Depressor anguli oris

            • Depressor labii inferioris

            • Digastric transposition 

            • Platysma 

Preparation

Procedure

Sample operative report

Post-op

Pearls & Pitfalls

High-Yield

Links