I have synkinesis on the right side of my face. I had Bells Palsy that came a long time ago.

Question

I started to get Synkinesis recently in the past 1 year. I live in North California and looking to see if there is any good means to review and fix this issue. I have not done any Botox yet because I am not seeing any person benefiting from it. Do we have a expert doctor in this area whom I am meet and check for further analysis. I am looking for a Doctor who has the right solution and done it before. I hear reconstructive surgery with nerve clipping but did not get more information on it.

Andre Panossian, MD · Answer

Synkinesis is a common and vexing problem for patients who have been slow to recover from facial paralysis of any kind, including Bell's palsy.  There are both conservative and aggressive treatments.  I typically like to see results from a conservative approach first and discuss more aggressive treatments down the line, if the initial approach fails or is no longer desired.  The conservative approach involves the precise use of small amounts of botox in conjunction with physical therapy by a facial paralysis specialist (not a routine PT or OT).  This approach is both diagnostic and therapeutic and will help guide treatment for possible synkinesis surgery.  The most aggressive approach for synkinesis is a combination of "nerve clipping" and selective muscle excision.  This surgery has yet to be perfected and should only be undertaken as a last line for patients with the most severe forms of synkinesis.  The surgery itself can produce paralysis, therefore, it is imperative to have a surgeon who has expertise in the facial nerve.  When underdone, the synkinesis may still persist following surgery.  The reason for this is that as the facial nerve branches out further into the face, it sends thousands of redundant nerve branches to all the muscles.  To effectively "clip" the nerves that are producing the synkinesis is very much like finding a needle in a haystack.  In reality, several nerves must be divided, some of which become microscopic as they enter the muscle.  Therefore, my approach will entail a precise excision of certain sections of offending facial muscles in conjunction with the neurectomy.

Leslie Kim, MD, MPH · Answer

Thank you for your question.  I have found that the great majority of my patients with synkinesis experience significant benefit to their symptoms and quality of life with a combination of facial therapy (facial neuromuscular retraining therapy) in conjunction with botox treatment.  Botox for synkinesis certainly requires special expertise so it is possible that those who you have spoken to did not obtained targeted treatment/benefit.  The surgery you are referring to is called selective neurolysis with or without platysmectomy; I typically reserve this for patients who fail the more conservative non-surgical treatment above.  Hope that helps, best of luck to you!

I have synkinesis on the right side of my face. I had Bells Palsy that came a long time ago.

Answers (2)

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