Abstract
Postparalysis facial synkinesis (PPFS) can develop in any facial palsy and is associated
with significant functional and psychosocial consequences for affected patients. While
the prevention of synkinesis especially after Bell's palsy has been well examined,
much less evidence exists regarding the management of patients with already established
synkinesis. Therefore, the purpose of this review is to summarize the available literature
and to provide an overview of the current therapeutic options for facial palsy patients
with established synkinesis. A systematic literature review was undertaken, following
the Preferred Reporting Items of Systematic Reviews and Meta-analyses 2020 guidelines.
MEDLINE via PubMed and Cochrane Library were searched using the following strategy:
([facial palsy] OR [facial paralysis] OR [facial paresis]) AND (synkinesis) AND ([management]
OR [guidelines] OR [treatment]). The initial search yielded 201 articles of which
36 original papers and 2 meta-analyses met the criteria for inclusion. Overall, the
included articles provided original outcome data on 1,408 patients. Articles were
divided into the following treatment categories: chemodenervation (12 studies, 536
patients), facial therapy (5 studies, 206 patients), surgical (10 studies, 389 patients),
and combination therapy (9 studies, 278 patients). Results are analyzed and discussed
accordingly. Significant heterogeneity in study population and design, lack of control
groups, differences in postoperative follow-up, as well as the use of a variety of
subjective and objective assessment tools to quantify synkinesis prevent direct comparison
between treatment modalities. To date, there is no consensus on how PPFS is best treated.
The lack of comparative studies and standardized outcome reporting hinder our understanding
of this complex condition. Until higher quality scientific evidence is available,
it remains a challenge best approached in an interdisciplinary team. An individualized
multimodal therapeutic concept consisting of facial therapy, chemodenervation, and
surgery should be tailored to meet the specific needs of the patient.
Keywords
facial palsy - synkinesis - systematic review - Bell's Palsy
