Degree of Self-Reported Facial Impairment Correlates with Social Impairment in Individuals with Facial Paralysis and Synkinesis

Krane, Natalie A.; Genther, Dane J.; Weierich, Kendall; Hanseler, Haley; Liu, Sara; Mowery, Alia; Loyo, Myriam

doi:10.1089/fpsam.2020.0082

Cited by 25 publications

(32 citation statements)

References 30 publications

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“…[1][2][3]9,54,55 An unnatural smile can lead to patients being perceived as hostile and has been shown to provoke negative responses from others. 9 Nonflaccid facial paralysis patients suffer from facial tightness, smile asymmetry, and inappropriate facial muscle movements. A natural smile can be achieved by reducing the action of synkinetic muscles and creating a balance between smile elevators and antagonists as described by the MSN.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Selective Neurectomy for Treatment of Post-Facial Paralysis Synkinesis: A Systematic Review

et al. 2022

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Background: Synkinesis is commonly encountered after flaccid facial paralysis and can have a detrimental impact on a patient’s life. First line treatment of synkinesis is chemodenervation with Botulinum toxin (Botox) and neuromuscular retraining. Surgical options include selective myectomy, selective neurectomy (SN), cross-facial nerve grafting, nerve substitution, and free gracilis muscle transfer (FGMT). Data on surgical management of synkinesis using selective neurectomy is limited. Evidence Review PubMed, Embase, Cochrane CENTRAL, Cochrane Neuromuscular Register, Clinicaltrials.gov, and WHO ICTPR were searched using a comprehensive keyword strategy in accordance with PRISMA guidelines. All English-only texts published in the last 20 years were included. Two independent investigators reviewed 906 abstracts and 7 studies met inclusion criteria. Demographics, etiology of paralysis, time to surgery, and primary outcomes studied were collected. Findings A total of 250 patients were included across 7 studies. In 6 out of 7 studies, Botox was used prior to surgical intervention. Two studies showed significant reduction in Botox dosage postoperatively, while one study showed no difference. Other primary outcomes included the House-Brackman Score, palpebral fissure width, eFACE score, Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Three studies showed significant improvement in the eFACE score, two studies showed significant improvement in the FaCE scale, while one study showed improvement in quality of life measured by the SAQ. Conclusions Selective neurectomy can be considered as an adjunct to other management options including neuromuscular retraining, Botox, selective myectomy and reanimation procedures. While there is great heterogeneity of study design in the studies included, many cohorts showed improvement in facial symmetry, facial function, and quality of life. There remains a great gap in knowledge in this subject matter and a need for large well designed prospective studies comparing this technique to other management options.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Selective Neurectomy for Treatment of Post-Facial Paralysis Synkinesis: A Systematic Review

et al. 2022

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“…Facial synkinesis is a condition characterized by unintentional facial muscle activation and the resulting mimic movement occurring simultaneously with intentional facial movements (1). Patients are often unable to fully control perioral and midfacial muscles resulting in problems during eating, drinking, and facial expression (1). Involuntary eye closure during intentional mouth movements while speaking or eating is considered a significant disturbing outcome.…”

Section: Introductionmentioning

confidence: 99%

Pathogenesis, diagnosis and therapy of facial synkinesis: A systematic review and clinical practice recommendations by the international head and neck scientific group

et al. 2022

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IntroductionPost-paralytic facial synkinesis after facial nerve injury produces functional disabilities and mimetic deficits, but also cosmetic and non-motor psychosocial impairments for the patients. These patients typically have a high and continuous high motivation for rehabilitation. The aim is to inform the affected patients and their therapeutic professionals (otorhinolaryngologist - head and neck surgeons; oral-maxillofacial surgeons, plastic and reconstructive surgeons, neurosurgeons, neurologists, and mime therapists be it speech and language therapy- or physiotherapy-based) and to provide practical recommendations for diagnostics and a stepwise systematic treatment approach of facial synkinesis.MethodsIn the first phase, a systematic literature search on the topic in PubMed and ScienceDirect starting in 2008 resulted in 132 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostic tests and treatment options. In the second phase, one consensus article circulated among the membership of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations.ResultsDiagnostics should include a standardized assessment of the degree of synkinesis using validated clinician-graded instruments and synkinesis-specific patient-reported outcome measures. Treatments for facial synkinesis include facial training mainly based on facial biofeedback retraining, chemodenervation with botulinum toxin, selective neurectomy, myectomy, and any combination treatment of these options.ConclusionA basic understanding of the pathomechanisms of synkinesis is essential to understand the treatment strategies. A standardized assessment of the synkinetic symptoms and the individual synkinesis pattern is needed. The first-line treatment is facial training, followed by botulinum toxin. Surgery is reserved for individual cases with unsatisfactory first-line treatment.

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“…2 Given the significant functional limitations of incomplete eye closure, nasal obstruction and oral incompetence, as well as the detrimental effect on cosmesis, longstanding facial paralysis can understandably have profound consequences on quality of life and mental health. [3][4][5][6] Some patients may also develop painful and disfiguring facial spasms as a result of synkinesis during nerve regrowth. 6,7 A central challenge to measuring FP deficits as well as functional and cosmetic outcomes is the often-subjective nature of diagnostic criteria.…”

mentioning

confidence: 99%

“…[3][4][5][6] Some patients may also develop painful and disfiguring facial spasms as a result of synkinesis during nerve regrowth. 6,7 A central challenge to measuring FP deficits as well as functional and cosmetic outcomes is the often-subjective nature of diagnostic criteria. A variety of grading scales have been developed with the goal of objectively quantifying the spectrum of severity and secondary features of facial paralysis.…”

mentioning

confidence: 99%

“…However, permanent FP or nonflaccid facial palsy may develop in patients, particularly when caused by iatrogenic injuries, benign or malignant tumors, congenital deficiencies or known infectious agents 2. Given the significant functional limitations of incomplete eye closure, nasal obstruction and oral incompetence, as well as the detrimental effect on cosmesis, longstanding facial paralysis can understandably have profound consequences on quality of life and mental health 3–6. Some patients may also develop painful and disfiguring facial spasms as a result of synkinesis during nerve regrowth 6,7…”

mentioning

confidence: 99%

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Trends in Facial Paralysis Management: A National Survey Study

Benyo

Saadi

Shokri

et al. 2022

Journal of Craniofacial Surgery

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Introduction: Advances in operative management, minimally invasive procedures, and physical therapy have allowed for dramatic improvements in functional and cosmetic outcomes in patients with facial paralysis. Our goal was to evaluate the current trends and practice patterns in the diagnosis and management of facial paralysis by provider demographics. Materials and Methods: An electronic questionnaire was distributed to members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Practice patterns in the diagnosis and treatment were compared by level of training (fellowship-trained facial plastic and reconstructive surgeon versus non-fellowship trained), practice type (academic and private), practice length, patient volume, and presence of a dedicated facial nerve clinic. The bivariate associations of the outcome variables and the stratification factors were analyzed using 2-way contingency tables and Fisher’s exact tests. Results: The survey was sent to 1129 members of the AAFPRS. The response rate was 11.7% (n=132). Most respondents were fellowship-trained surgeons (79%) in the academic setting (55%), and most have been in practice for more than 10 years (53%). Practice setting and patient volume were the factors most associated with significant variations in management, including the use of facial paralysis grading scales, photography/videography, patient-reported outcome metrics, as well as differences in both noninvasive and surgical management. Conclusion: Based on the present study, several physician demographic factors may play a role in choosing which diagnostic and treatment options are employed for facial paralysis, with practice setting and patient volume appearing to be the 2 variables associated with the most significant differences.

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Degree of Self-Reported Facial Impairment Correlates with Social Impairment in Individuals with Facial Paralysis and Synkinesis

Cited by 25 publications

References 30 publications

Selective Neurectomy for Treatment of Post-Facial Paralysis Synkinesis: A Systematic Review

Selective Neurectomy for Treatment of Post-Facial Paralysis Synkinesis: A Systematic Review

Pathogenesis, diagnosis and therapy of facial synkinesis: A systematic review and clinical practice recommendations by the international head and neck scientific group

Trends in Facial Paralysis Management: A National Survey Study

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