Botulinum Toxin Type A Timing Efficacy in Patients With Synkinesis After Bell's Palsy.

OBJECTIVE: This study examines whether the timing of botulinum toxin type A (BoNTA) treatments affects outcomes in patients with synkinesis, a sequela of Bell's Palsy characterized by disconjugate facial muscle movement. STUDY DESIGN: A retrospective chart review. SETTING: An urban academic medical center. METHODS: We reviewed the charts of synkinesis patients treated from 2016 to 2022. Data included procedural notes, intervention dates, and scores from the House-Brackmann (HB), Facial Clinimetric Evaluation (FaCE), Synkinesis Assessment Questionnaire (SAQ), and Facial Grading System (FGS). RESULTS: Sixty-seven patients (median age 54 years, average palsy duration 5.7 years) received BoNTA. Patients treated within 12 months (n = 28), 13 to 24 months (n = 12), and after 24 months (n = 23) showed no significant differences in changes to HB, FaCE, or SAQ scores. However, patients treated within 1 year had significantly higher FGS improvement (36.3) than the other groups (P = .03). CONCLUSION: While FaCE, HB, and SAQ scores showed no significant differences, early BoNTA treatment within 1 year significantly improved FGS scores, indicating better outcomes. Therefore, early treatment is ideal for optimal response.