Facial Synkinesis

1. FACIAL SYNKINESIS
ADE WIJAYA, MD – NOVEMBER 2018

2. Outline:
- Introduction
- Pathomechanism
- Etiology
- Diagnosis
- Management
- Summary

3. Introduction
Involuntary movement of the facial mimetic musculature accompanying voluntarily facial
movements
As a sequalae of facial nerve injury
Socio-emotional impacts
Husseman J, Mehta RP. Management of synkinesis. T Facial Plast Surg 2008; 24:242–249

4. Pathomechanism
Aberrant, nonspecific nerve regeneration
Ineffective myelination leading to ‘crosstalk’ between distal nerve fibers
Reorganization and hypersensitization of the facial nucleus
Crumley RL. Mechanisms of synkinesis. Laryngoscope 1979; 89:1847–1854.
Couch SM, Chundury RV, Holds JB. Subjective and objective outcome measures in the treatment of facial nerve synkinesis with onabotulinumtoxin A (botox). Ophthalm Plast Reconstr Surg 2014; 30:246–250.

5. Etiology
Most often:
- Bell’s palsy
- Tumor resection (acoustic neuroma, parotid gland)
Less often:
- Multiple sclerosis
- Genetics
- Traumatic injuries (delivery trauma)
- Congenital (developmental defects)
- Infection (Lyme disease, Ramsay-Hunt)
- Vascular compression
Markey JD, Loyo M. Latest advances in the management of facial synkinesis. Current opinion in otolaryngology & head and neck surgery. 2017 Aug 1;25(4):265-72.

6. Diagnosis
Physical examination:
- Static and dynamic motor findings
- Non-motor findings: gustatory hyperlacrimation and the production of copious tears, or
‘crocodile tears’, during salivation.
MRI in selected cases
Cabin JA, Massry GG, Azizzadeh BB. Botulinum toxin in the management of facial paralysis. Curr Opin Otolaryngol Head Neck Surg 2015; 23:272–280.
Chuang DC, Chang T, Chuieng-Yi L. Postparalysis facial synkinesis: clinical classification and surgical strategies. Plast Reconstr Surg Glob Open 2015; 3:320.

7. Management
Physical Rehabilitation
Botox Injection
Surgery
Markey JD, Loyo M. Latest advances in the management of facial synkinesis. Current opinion in otolaryngology & head and neck surgery. 2017 Aug 1;25(4):265-72.

8. Summary
• Involuntary movement of the facial mimetic musculature accompanying voluntarily facial
movements
• As a sequalae of facial nerve injury
• Socio-emotional impacts
• Most common etiologies: Bell’s palsy & tumor resection
• Physical examination: motoric and non motoric (crocodile tears)
• Treatment: physical rehabilitation, botox injection, and surgery