2018 Volume 34 Issue 1 Pages 31-36
Although facial synkinesis and contracture are distressing consequences of incomplete recovery form facial paralysis, there is no consensus regarding its preferred treatment. In this report, we present our therapeutic strategy and methods, including non-surgical and surgical treatments, for facial synkinesis and contracture.
Our non- surgical treatments include（1）facial neuromuscular retraining and（2）botulinum toxin type A（BTX-A）injections for selective chemodenervation of the affected muscle groups. Our surgical treatments include（1）myectomy and selective neuromyectomy to decrease muscle contraction,（2）blepharoplasty, nasolabialplasty and face-lift to repair the facial deformity caused by facial contracture, and（3）neurorrhaphy between the branches of the facial nerve and the hypoglossal nerve and/or the masseter nerve using a nerve graft to improve synkinesis and recovery from facial paralysis.
Non- surgical methods are less invasive and suitable for first-choice treatments. However, not all patients can continue non-surgical treatments, because the effects of BTX-A are temporary, and neuromuscular retraining generally takes a long time and a good outcome is not guaranteed. We think that combined BTX-A and surgical treatments in a patient-tailored graduated fashion based on facial neuromuscular retraining is necessary.
