Review of Treatment Options for Facial Synkinesis: Working Towards a Standardized Algorithm

Background Facial synkinesis describes a sequela of transient facial nerve injury that can occur following viral reactivation syndromes such Bell's palsy or following traumatic facial nerve injury. Facial synkinesis is frequently characterized by muscle hypertonicity, involuntary co-contraction of facial muscles, and spasm, and can have severe functional and aesthetic consequences. Although this condition is not curable, several treatment options exist; however, there is currently a lack of consensus regarding the appropriate timeline and sequence of synkinesis treatment strategies. Summary Treatment for facial synkinesis is nuanced and constantly evolving. A range of both noninvasive and invasive treatment options exist, including physical therapy, chemodenervation with botulinum toxin, and various surgical interventions such as selective myectomy and selective neurectomy. The optimal treatment strategy is often dependent on patient preference, clinical presentation, and provider comfort, and can be further complicated by confusion regarding the appropriate timeline for escalation of care. This review summarizes the current treatment trends and proposes a nuanced algorithm that integrates current practice and individualized decision-making to provide a framework to care for this patient population. Key Messages Management of facial synkinesis is complicated by the wide range of treatment options in addition to the lack of clear consensus on how to integrate these modalities into a cohesive treatment plan. The algorithmic approach outlined here represents one of several possible frameworks for evaluating and managing patients with this challenging condition.