Facial synkinesia before and after surgical reanimation of the paralyzed face.

BACKGROUND: Facial synkinesia is a common sequela of facial palsy, affecting 15 to 20 percent of patients. The rate of postoperative synkinesia after facial reanimation is not clearly established. The severity and type of synkinesia determine the degree of clinical relevance. METHODS: One hundred sixty-seven patients with facial palsy were included in this retrospective cohort study. Three-dimensional video analysis of facial movements was performed preoperatively and 18 months after facial reanimation. The severity of synkinesia was rated subjectively on a four-degree severity scale. Objective three-dimensional analysis of synkinesia was performed on patients with 18-month follow-up times. RESULTS: Preoperatively, 84.4 percent of patients were not affected by synkinesia, 9 percent presented with mild synkinesia, 4.2 percent presented with moderate synkinesia, and 2.4 percent presented with severe synkinesia. Postoperatively, 51 percent of all patients presented with facial synkinesia (41.8 percent mild, 17.3 percent moderate, and 1 percent severe synkinesia; some patients had more than one type). Patients treated with territorially differentiated gracilis muscle transplantation were most frequently affected (69.8 percent), followed by patients treated with gracilis muscle transplantation in combination with temporalis muscle transposition to the eye (51.8 percent). Oculo-oral synkinesia was the most frequent form of synkinesia. CONCLUSIONS: After surgical reanimation of the paralyzed face, half of the patients presented with synkinesia. The majority of patients developed mild or moderate forms of synkinesia; therefore, the clinical relevance of synkinesia has to be seen in the context of total facial function. Because of the high prevalence of synkinesia, it should be documented and addressed in patients undergoing facial reanimation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.