Facial synkinesis can be present in both primary and postparalytic hemifacial spasm (HFS). The present retrospective study aimed to summarize the clinical features of synkinesis and explore an appropriate botulinum toxin A (BoNT-A) injection strategy to manage the synkinesis accompanying HFS. Video recordings of 234 patients with primary and postparalytic HFSs were analyzed. Improvements in the severity of spasm and synkinesis owing to BoNT-A treatment were monitored and compared among 36 primary and 12 postparalytic HFS patients with synkinesis and completed follow-up records. BoNT-A was injected into the voluntary facial region (VFR), the synkinetic facial region (SFR), or both VFR and SFR, and the efficacy of these strategies was evaluated and analyzed. Oral-ocular synkinesis in the primary group (32.8%) and ocular-oral synkinesis in the postparalytic group (81.0%) showed the highest incidence. Patients in both the primary and postparalytic groups exhibited a tremendous alleviation of spasm (97.2% vs. 91.7%, P > 0.05) following BoNT-A treatment. In both groups, coinjection and SFR injection were commonly used and effective in treatment of ocular and oral synkinesis, while VFR was frequently used but ineffective for frontal synkinesis. In addition, the improper muscle selection surrounding the mouth corner resulted in pattern change and treatment failure of oral synkinesis. Synkinesis mostly affected the ocular and oral regions. BoNT-A, via treatment of SFR, is effective against synkinesis accompanying HFS.

目的 探讨A型肉毒毒素(botulinum toxin type A,BoNT-A)治疗原发性及面瘫后面肌痉挛患者痉挛及伴随联带运动的疗效差异.方法 选取2009年1月-2018年7月具有联带运动的面瘫后面肌痉挛患者12例,按照1∶2配比性别无差异且具有联带运动的原发性面肌痉挛患者24例,分析2组BoNT-A治疗后痉挛严重程度以及伴随联带运动的改善差异.结果 面瘫后及原发性面肌痉挛患者在起效时间[(4.38±2.17) vs.(4.67±4.14)d],维持时间[(3.83±2.94) vs.(4.96±2.48)d],注射剂量[(31.35±12.30) vs.(26.98±8.75) U]方面无明显差异(P＞0.05).原发性面肌痉挛组患者满意度显著较高(84.79±19.81 vs.64.17±31.54,P＜0.05).2组痉挛改善有效率均高于90％,组间无明显差异(91.67％ vs.95.83％,P＞0.05).2组联带运动均有改善,但无明显差异(83.33％ vs.58.33％,P＞0.05).5个自主动作相关联带运动改善方面仅发现原发性面肌痉挛患者噘嘴引起联带运动的改善有明显差异(P＜0.05).结论 BoNT-A可以显著改善原发性与面瘫后面肌痉挛患者的痉挛严重程度,在联带运动严重程度改善方面有一定疗效.原发性面肌痉挛患者噘嘴引起的联带运动在BoNT-A治疗后显著改善.

目的 探讨原发性面肌痉挛联带运动的临床特征.方法 对212例原发性面肌痉挛患者的病史资料及临床录像资料进行整理,选择与联带运动相关的3个解剖部位(额部、眼部及口部),观察3个联带运动动作(眉弓抬高、眼裂缩小、口角牵动)及5个自主动作(抬眉、皱眉、闭眼、示齿及噘嘴),分析原发性面肌痉挛患者人口学特点、联带运动临床特点、联带运动严重程度及个数与面肌痉挛严重程度的相关性.结果 原发性面肌痉挛患者发病年龄(56.07±12.40)岁,病程(54.90±59.96)个月.针对47例5个基本动作完备的原发性面肌痉挛患者进行联带运动类型相关分析,其中口-眼联带运动模式最常见[55.32％(26/47)],噘嘴是最容易引起联带运动的自主动作[55.32％(26/47),P<0.01],眼裂缩小是最常出现的联带运动动作[57.45％(27/20),P<0.05],其中噘嘴引起睑裂缩小是最常见的联带运动类型[55.32％(26/47)],联带运动严重程度和面肌痉挛严重程度无相关性,同时联带运动个数多少与面肌痉挛严重程度无相关性.结论 原发性面肌痉挛联带运动发生占一定比例,其中噘嘴引起的睑裂减小、噘嘴引起的眉弓抬高、闭眼引起的口角牵动是最常见的三种联带运动模式,眼裂缩小是最常出现的联带运动动作,可为临床上联带运动的识别和面肌痉挛精细化治疗提供理论基础.联带运动是一种独立的现象,临床中应该重视对其的识别.