Facial Paralysis: Contemporary Concepts and Treatment Strategies with an Emphasis on Synkinesis

This review aims to present contemporary strategies for the evaluation and treatment of facial paralysis, with particular emphasis on postparetic synkinesis. It explores the anatomy and function of the facial nerve, mechanisms of injury, classification systems, and current management paradigms, highlighting the distinct pathophysiology and therapeutic considerations for synkinesis. Postparetic synkinesis is a common sequela of facial paralysis, best managed through a tailored, multimodal approach. In most scenarios, treatment focuses on weakening hypertonic muscles and interrupting aberrant neural pathways responsible for abnormal movements, using botulinum toxin and targeted surgical interventions, although variations in treatment exist and should be patient specific. Common procedures include selective myectomies and selective neurectomies. In certain cases, free functional muscle transfer can improve smile dynamics. Combined therapies typically offer better outcomes than single modalities. Facial paralysis management, particularly for synkinesis, requires an individualized, multidisciplinary approach integrating aesthetic and functional goals. Ongoing research and innovation continue to refine therapeutic techniques and outcome metrics, improving quality of life for affected patients.