Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of post-paralytic facial synkinesis following prior facial nerve palsy. Reports involuntary muscle contractions during volitional movement, specifically [e.g., eye closure on smiling, platysmal banding on mouth opening]. Symptoms significantly impact facial symmetry and social confidence. No history of recent trauma or acute infection.
Clinical Examination Findings
Facial examination reveals resting asymmetry with [e.g., narrowed palpebral fissure, deepened nasolabial fold]. Dynamic assessment demonstrates aberrant reinnervation: ocular synkinesis noted upon oral commissure elevation; platysmal hypertonicity during lip pursing. Sunnybrook/House-Brackmann score: [Score]. Facial muscle tone is hypertonic in the affected zones.
Treatment Protocol
Treatment plan initiated with targeted Botulinum Toxin Type A injections to hyperkinetic muscle groups (orbicularis oculi, platysma, depressor anguli oris) to reduce synkinetic activity. Adjunctive facial neuromuscular retraining (biofeedback) recommended. Surgical consultation for selective neurectomy or myectomy discussed if conservative management fails.