Facial synkinesis refers to the “simultaneous movement” that occurs after Bell’s palsy or instances where the facial nerve has been cut and sewn back together. After Bell’s palsy, the facial nerve fibers may be implanted into different muscles. Or, if the facial nerve has been resewn, the facial nerve fibers may reconnect to the wrong nerve group, leading to undesired and simultaneous facial movements.
Synkinesis results in an abnormal synchronization of facial movement. When this happens, an involuntary facial movement may occur during voluntary movement of a different facial muscle group.
What Are the Signs of Synkinesis?
Common signs include:
- The eyes narrow when an individual smiles
- The cheek lifts when a person closes his or her eyes
- The neck muscle tightens when a person tries to whistle
- Facial twitching in the cheek and chin
- Facial muscles become tight, leading to facial pain and headaches
- A deeper cheek crease forms on the affected side of the face, causing the cheek to appear bulky
Many symptoms associated with synkinesis include the following:
- Increased tone in the facial muscles: Muscle tone may increase in the affected side of an individual’s face. In fact, a person likely will need to work two to three times harder to move these muscles than he or she would to move the muscles in the unaffected side of the face.
- Short, tight facial muscles: Facial muscles may become short and tight if they are overworked for an extended period of time. When this occurs, it may be difficult for an individual to move the muscles to display facial expressions.
- Linked facial movements: Linked facial movements will happen if a recovering facial nerve is poorly insulated. In this scenario, the message to move a particular muscle may be picked up by a nearby muscle, resulting in several simultaneous muscle movements (ie. when the patient smiles their eye narrows and closes too). Furthermore, linked facial movements may continue to occur after the facial nerve has fully recovered.
- Coordination problems: Coordinating facial movements can be exceedingly difficult, particularly for those who are recovering from a facial nerve issue.
A synkinesis patient may display various facial muscle patterns. In many instances, a patient’s eyes may twitch or close when this individual laughs or smiles. Also, facial synkinesis may cause the corner of the mouth to pull upward in patients who have regained their facial tone. The synkinetic (simultaneous) movement of muscles can cause the corner of the mouth (depressor anguli oris, platysma and mentalis muscles) to droop and elevate nearby muscles (zygomaticus major and minor). Therefore, it may be difficult for a synkinesis patient to smile appropriately.
Other signs of facial synkinesis include:
- Dimpling in the chin
- Narrowing of the eye affected
- Increased facial muscle spasms
- Tightness of the neck bands and cheeks
Synkinesis often results in abnormal facial muscle patterns that can range in severity. As a result of Dr. Azizzadeh’s advancements in the field of facial reanimation surgery, patients now have several treatment options to choose from.
How Is Synkinesis Diagnosed?
A physical examination and a medical history assessment are required to provide an accurate diagnosis. The location of a facial nerve injury and the severity of the injury can also help a doctor determine if a patient is dealing with synkinesis.
Facial Paralysis vs. Synkinesis
Many patients ask us to explain the difference between facial paralysis vs. facial synkinesis. In the video below, our occupational therapist, Jackie Diels, explains the two conditions.
How to Prevent Synkinesis
Synkinesis cannot be prevented, however, there are certain things that patients can do to minimize its effect after Bell’s palsy.
“Facial re-education” is sometimes used to help minimize the effects of synkinesis after Bell’s palsy. It involves teaching a patient how to perform various facial muscle movements, such as keeping the face up when speaking and chewing food with the eyes open. Facial re-education also involves wearing sunglasses to prevent squinting and massaging the intraoral buccal area.
Facial re-education may be required for up to four months after Bell’s palsy. Patients generally work on slow and symmetric movements, and over time, these movements help improve facial muscle coordination.
It is important to consult with an experienced occupational therapist or physical therapist who is specifically trained in treating facial nerve disorders. They can provide the patient with a specific set of exercises that are appropriate for their unique presentations of Bell’s palsy.
Treatment is based on three modalities:
Synkinesis treatment can be administered any time after the condition is diagnosed. Furthermore, a patient can use neuromuscular retraining, Botox or surgery to treat synkinesis even years after suffering from Bell’s palsy or facial paralysis.
Selective neurolysis, also referred to as modified selective neurectomy, is the most advanced surgery option for patients with synkinesis. Dr. Azizzadeh pioneered the selective neurolysis procedure for his patients who could not generate a proper smile due to their synkinesis and partial facial paralysis.
Patients who do not fully recover from Bell’s palsy are likely to develop synkinesis. Because synkinesis is a result of the facial nerves becoming “mis-wired,” when these patients use various muscles (depressor anguli oris, platysma, orbicularis oris and buccinators) to produce a natural smile, the end result is often an asymmetric smile. To treat this issue, the facial nerves must be re-wired to reduce the activity of the nerves that negatively impact a patient’s ability to create a natural smile.
Dr. Azizzadeh uses selective neurolysis to correct “mis-wiring” of the facial nerve. He performs selective neurolysis at an outpatient surgery center, and the risks associated with the procedure are generally minimal in comparison to other facial reanimation surgeries.
Modified selective neurectomy enhances facial and smile symmetry and improves facial muscle coordination. It also reduces functional tightness in the face and ensures an individual is well-equipped to smile naturally.
During selective neurolysis, Dr. Azizzadeh releases the platysma muscle, decreasing nerve activity that pulls the mouth downward and enabling the corners of the mouth to turn upward once again. Furthermore, selective neurolysis is a complex and intricate procedure, but the recovery period is rather minimal, similar to that of a facelift.
Selective neurolysis typically delivers immediate results. Whereas some facial reanimation surgeries require two to three years before a patient achieves the final results, initial selective neurolysis treatment results may become visible within one day of surgery.
Each selective neurolysis procedure is customized to a patient. Prior to treatment, Dr. Azizzadeh evaluates a patient’s smile capabilities to determine if he or she is a good candidate for selective neurolysis. If Dr. Azizzadeh believes selective neurolysis can help a patient produce a natural smile, he then crafts a personalized treatment plan.
Other treatment options to address synkinesis include:
- Static suspension of the corners of the mouth
- Blepharoplasty (eyelid surgery)
- Asymmetric Facelift
During your consultation, all options are discussed at length to determine if you are an appropriate candidate.
Botox for Synkinesis
Botox may be used in combination with selective neurolysis and/or facial neuromuscular therapy. It reduces muscle activity, minimizing the synkinesis effects associated with overactive and uncoordinated muscles.
The most common injection areas for Botox are:
- Eye muscles (orbicularis)
- Neck bands (platysma)
- Chin dimpling (mentalis)
Botox can also be used to improve facial symmetry by reducing the activity of certain muscles on the normal side of the face, such as:
- Lower lip depressors (depressor anguli oris)
- Crow’s feet (orbicularis)
Physical Therapy and Neuromuscular Retraining for Synkinesis
Facial neuromuscular retraining emphasizes the coordination of appropriate facial muscle movements. With facial neuromuscular retraining, a synkinesis patient can limit abnormal movement patterns that otherwise would result in “auto-paralysis” of different facial muscle groups.
During physical therapy, the muscles that are contracting out of sequence will be identified. Then, a multi-step process is used to help a patient retrain the muscles at the neurological (brain) level. Our therapists may use both neuromuscular retraining and massage techniques to provide you with the best results.
Electrical stimulation increases overactive muscles, and as such, should not be used as part of neuromuscular training. Instead, tight overactive muscles are manually massaged and stretched. For example, patients are taught how to relax the affected eyelids to reduce eye synkinesis. In addition, neuromuscular retraining focuses on muscle re-coordination rather than stimulation, and synkinesis patients should not perform muscle-strengthening exercises as part of this treatment.
Typically, 90 percent of synkinesis exercises can be performed at home. A therapist will teach a patient how to perform these exercises properly and ensure that he or she fully understands the ins and outs of each exercise. The therapist may teach a patient how to perform mirror and video exercises as well.
What To Expect During A Synkinesis Treatment Consultation With Dr. Azizzadeh
A synkinesis treatment consultation allows Dr. Azizzadeh to learn about a patient. At the same time, a patient can review his or her synkinesis treatment options.
Initially, Dr. Azizzadeh performs a series of tests to assess a patient’s synkinesis symptoms. Dr. Azizzadeh then develops a personalized synkinesis treatment plan. He also answers a patient’s synkinesis questions and ensures he or she can make an informed treatment decision.
Dr. Azizzadeh maps out all aspects of a synkinesis treatment as well. He describes how long a synkinesis treatment requires to complete and enables a patient to establish realistic recovery expectations. Plus, Dr. Azizzadeh offers detailed instructions to help a patient prepare for his or her synkinesis treatment.
Are synkinesis symptoms identical for all patients?
Every synkinesis patient is different, and the severity of synkinesis symptoms vary from patient to patient. For example, some patients will experience muscle tension in their neck, while others will have facial twitching.
Does Bell’s palsy cause synkinesis?
In most cases, Bell’s palsy symptoms disappear on their own. Approximately 10 percent of Bell’s palsy patients experience synkinesis, and 5 percent suffer complete facial paralysis.
If an individual has experienced Bell’s palsy symptoms for eight months or longer, a consultation with Dr. Azizzadeh is crucial. At this point, Dr. Azizzadeh performs an in-depth patient evaluation to determine if an individual is dealing with synkinesis or complete facial paralysis.
Are synkinesis treatments safe?
Dr. Azizzadeh performs a synkinesis treatment only if he believes it can help a patient safely and effectively achieve his or her desired results. He also conducts an in-depth evaluation of a patient to identify any potential synkinesis treatment risks. If Dr. Azizzadeh believes the risks of a synkinesis treatment exceed its benefits, he offers alternative treatment options.
How long does it take before I will see the results of a synkinesis procedure?
The results of a synkinesis procedure become transparent shortly after treatment. However, each patient is different, and each synkinesis treatment is tailored to a patient. This means some patients will see the results of a synkinesis treatment faster than others.
Dr. Azizzadeh helps his patients set realistic expectations for a synkinesis treatment. Before he performs a synkinesis procedure, he establishes a plan that offers insights into all aspects of treatment. This helps a patient understand what to expect in the days, weeks and months after a synkinesis procedure.
How long does it take to recover from a synkinesis procedure?
Dr. Azizzadeh strives to help patients recover from synkinesis procedures as quickly as possible. He provides full details about a synkinesis treatment’s recovery period, as well as offers tips and recommendations to streamline the recovery process.
What is the best treatment for synkinesis?
A synkinesis patient evaluation is required to determine the optimal treatment. With a patient evaluation, Dr. Azizzadeh analyzes a patient’s synkinesis symptoms. Dr. Azizzadeh then crafts a custom treatment plan to help a patient permanently address his or her facial paralysis.
Contact The Facial Paralysis Institute Today!
Dr. Azizzadeh is a globally recognized facial plastic and reconstructive surgeon who is happy to treat synkinesis patients. If you or a loved one are experiencing synkinesis, please contact our office today to learn more about our cutting-edge treatment options.
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