Postparetic Facial Synkinesis-Surgical Treatment and Rehabilitation

Postparetic facial synkinesis (PPFS) is noted in a minority of patients after recovery from a previously paralytic face, causing co–contraction of the involved facial muscles. PPFS is unbelievably distressing to the affected patients. Disfiguring (while the patient is attempting one facial movement, an unintentional movement of another part of the face is noted) and debilitating (tightness of face and neck) conditions will interfere with the daily social interaction of these patients.

Between 1986 and 2002, 172 patients with facial palsy were treated by surgery. Fifteen patients (9%) presented with PPFS, 7 with sequelae to Bell's palsy, 6 with facial trauma and surgical injury to the facial nerve after tumor ablation. The duration between facial paralysis and recovery usually takes 6 months or longer. But the time interval between the established PPFS and the request for surgical correction was 9 years on average (range, 2–20 years). The average age of patients at the time of surgical correction was 25 years (range, 20–30). There were 5 males and 11 females. All patients had sought referrals, medical or surgical, for treatment years before, including rehabilitation therapy and botulinum toxin injections, and some had myotomy and myectomy surgical procedure. All patients underwent a three–stage surgical protocol and postoperative rehabilitation of smiling training for the treatment of the synkinesis sequel: stage 1 operation (preparation), cross face nerve graft ; stage 2 operation (destruction), neurectomy and myectomy; stage 3 operation (restoration), functioning free muscle transplantation. Once the transferred muscle becomes mobile, smiling educational training starts. All patients were followed up for at least 2 years. The preliminary results were encouraging and were presented.