Selective Neurolysis for Synkinesis

Patients who have experienced Bell’s palsy or partial improvement in their facial paralysis can develop synkinesis (read more here).  This problem does not always occur, but when present, it can be mild to severe.  Physical therapy and targeted Botox® injections are still the preferred option in the treatment of synkinesis.  However, in some instances, synkinesis may persist despite prolonged treatment.  In these cases, surgery may help disrupt the divergent neural pathways that are responsible.  Dr. Panossian is has extensive experience into the treatment of this condition and has developed a unique surgical strategy.  He works closely with facial rehabilitation therapists to coordinate treatment for those who continue to struggle with synkinesis.

Targeted Nerve Destruction (Neurolysis)

Surgery to treat synkinesis requires understanding the aberrant pathways of stimulation that occur in a person recovering from facial paralysis or Bell’s palsy.  Through initial treatments using selective Botox® injections, these pathways can be better elucidated.  Targeted nerve destruction, or neurolysis, can then be performed with greater accuracy.  This involves identifying the nerve branches that are the culprit through a facelift approach.  Nerve monitors are used to very carefully identify tiny branches in the area of interest.  They are then stimulated to verify the targeted pathway before dividing them.

Targeted Muscle Destruction (Myectomy)

As an adjunct to neurolysis, targeted muscle release or destruction can be performed to diminish unwanted twitching or contraction.  This involves identification of the overactive muscles prior to surgery and possibly targeting them initially with Botox® injections.  For example, muscles such as the lower lip depressors and the platysma (broad muscle extending from the jawline down into the neck) can be weakened to reduce their downward force on the lower lip.  Accessory muscles responsible for nasal twitching can similarly be weakened surgically to prevent troublesome contractions.

Other techniques are currently being explored for their usefulness in synkinesis.  Cross-face nerve grafts and nerve transfers are possible options that may help deliver “clean” stimulation to areas of synkinesis.  Dr. Panossian is an expert in the treatment of synkinesis. Call today for a consultation, if you are experiencing synkinesis or residual facial paralysis.