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Synkinesis

Synkinesis is a condition that often develops after facial nerve injury or paralysis. It refers to disordered regrowth of the facial nerve that causes involuntary muscle movements that occur when you try to perform a voluntary facial movement. For example, when you try to smile, your eye may involuntarily close, or your neck may twitch when you try to pucker your lips. It is a biproduct of the amount of time the nerve is taking to get better and is often noticed at around 4 months post injury.

Common causes include:
– Bell’s palsy
– Facial nerve trauma or surgery
– Tumours affecting the facial nerve/recovery from removal of tumours
– Ramsay Hunt Syndrome (shingles affecting the facial nerve)

Symptoms of Synkinesis
– Eye closing when smiling or eating
– Mouth pulling when blinking
– Discomfort or facial fatigue

Treatment Options for Synkinesis
While synkinesis can’t be fully cured, many patients experience improvement with the right combination of treatments. Current best practices involve a multidisciplinary approach, often including:
1. Face Physiotherapy
– Face physical therapy helps retrain facial muscles and control unwanted movements.
– Focuses on relaxation, coordination, and muscle isolation.
– Guided by a therapist trained in facial nerve rehabilitation.

2. Botulinum Toxin (Botox) Injections
– Helps relax overactive muscles and reduce involuntary movements.
– Often injected into specific muscles around the eye, mouth, or neck.
– Effects last about 3–4 months; treatments are repeatable and adjustable.
* the gold standard of care is to couple PHYSIO + BOTOX

This information sheet was prepared by Dr Ellie Seckold, the principle physiotherapist at The Facial Physio. Reviewed by Associate Professor Catherine Meller (MBBS, FRACS(OHNS), MCL, MBA, BAppSc)