Latest advances in the management of facial synkinesis

Jeffrey D. Markey, Myriam Loyo

Research output: Contribution to journalReview articlepeer-review

26 Scopus citations


Purpose of review: To provide an overview of the treatment options for nonflaccid facial paralysis including physical rehabilitation, botulinum toxin injection and surgical intervention. To also describe recent technique advances regarding facial synkinesis in each zone of facial movement. Recent findings: Physical therapy and neuromodulation with botulinum toxin continues to be the main treatment strategy for facial synkinesis. Treating the orbicularis oculi, mentalis and platysma muscles with neurotoxin has been well described. A symmetric smile can also be improved with ipsilateral depressor anguli oris and the contralateral depressor labi inferioris weakening. Novel surgical techniques to selectively ablate specific facial muscles have also been recently described. Summary: Nonflaccid facial paralysis is a spectrum of hypokinetic and hyperkinetic movement following facial nerve injury that is best treated in a patient-tailored graduated fashion. Novel techniques are evolving to maximize patient function while minimizing morbidity.

Original languageEnglish (US)
Pages (from-to)265-272
Number of pages8
JournalCurrent Opinion in Otolaryngology and Head and Neck Surgery
Issue number4
StatePublished - Aug 1 2017


  • botulinum toxin
  • nonflaccid facial paralysis
  • selective neurectomy
  • synkinesis

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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