Synkinesis means “simultaneous movement,” it is essentially a faulty re-wiring of the facial nerves that causes unwanted contractions of muscles in the face. This can present itself as a forceful eye closure when smiling or other facial and neck spasms during normal facial movements. It can significantly affect a person’s quality of life, and the symptoms don’t go away without treatment.
What Causes Synkinesis?
Synkinesis can sometimes occur in patients who have previously had facial nerve injuries such as Bell’s palsy. When nerves are damaged, they can be miswired from faulty regeneration. This can also occur when nerves are sewn together to repair nerve damage, especially if the nerve fibers are connected to the wrong nerve groups. This means that when a nerve is triggered to make us smile, it can trigger another nerve forcing the eye to close. This type of synkinesis is referred to as ocular-oral synkinesis.
What Treatment Options Are Available for Synkinesis?
Several treatment options are available, including physical therapy, Botox and surgical options. Surgical options are only considered where patients don’t respond to physical therapy or Botox.
- Facial neuromuscular retraining: This is a form of physical therapy aimed at retraining the facial muscles to decrease unwanted facial movements while increasing desired movements. Massage and stretching of overactive muscles can also help to improve correct muscle movement. In addition, mirror biofeedback can allow a patient to modify muscle activity by decreasing or increasing muscle contractions.
- Botox: This treatment requires a medication called botulinum toxin type A (BTX-A) to be injected with fine needles. This blocks the release of neurotransmitters at nerve endings, preventing muscle contraction. Botox is commonly used to treat the eye muscles (orbicularis oculi), neck muscles (platysma) and chin dimpling (mentalis). Botox is also used on the other side of the face to create symmetry. This procedure is completely reversible and risk-free, with results lasting up to 3-4 months.
- Surgery: Surgery can be considered when physical therapy and Botox are ineffective or the severity of synkinesis is severe. Selective nerve transection of synkinesis (selective neurectomy) is a minimally invasive procedure that cuts one or more branches of nerves. Cutting these nerve branches allows muscles to relax, such as the over-closure of the eyelids. If neck muscles are constantly tight, then a small amount of superficial neck muscle (platysma) may be removed permanently without functional problems. In some cases, a muscle from another part of the body, such as the thigh, is transferred along with its nerves and veins. This procedure is a microsurgery that can mimic natural movements such as smiling.
If you have facial nerve damage, contact New York Facial Paralysis. We are the leading medical practice in the field of facial paralysis. Click here to schedule an appointment with a specialist or call us on (212) 371-3223.