Mechanisms and Management of Postparalysis Facial Synkinesis

Facial synkinesis is one of the most severe sequelae of facial nerve paralysis, and it can result in facial movement disorders, abnormal facial expressions, and even problems of social communication. The underlying mechanism of postparalysis facial synkinesis remains unclear. In recent years, researchers have demonstrated several possible mechanisms of facial synkinesis, including aberrant regeneration, ephaptic transmission, overacting of the facial nucleus in the pons, and changes in the cerebral cortex. Management includes botulinum toxin type A (BTX-A) injection, surgery, and neuromuscular reeducation.