Treatments for FP
Facial tightness (synkinesis)
Facial synkinesis is a condition that can occur after a person recovers from facial palsy (also known as Bell’s palsy or other types of facial nerve paralysis). It involves involuntary muscle movements or contractions on the face, which happen when the facial nerve, which controls facial muscles, starts to heal but doesn't re-wire in the correct way. As a result, when you try to move one part of your face, other muscles in the face move as well, leading to unintentional or abnormal movements. For example, a person might try to smile, but their eye might squint or the cheek might twitch at the same time.
These unwanted movements can affect the symmetry and control of facial expressions. As a result, it can have a determinantal impact on an individual’s overall appearance and self-confidence. In addition, the tightness from synkinesis is often painful.
There are three main treatments for facial synkinesis:
1. Facial physiotherapy
- Initially, facial massage and stretching exercises are initiated to stretch out the tight, over-active facial muscles. There are some excellent self-help videos available from Facial Palsy UK that show how to perform these (Management of Synkinesis (Tight Face) - Facial Palsy UK)
- Neuromuscular re-training can be offered by specialist facial therapists to help improve the coordination of the facial muscles and minimise any unwanted or involuntary movements. Targeted exercises, mirror therapy, relaxation techniques and neuromuscular re-education are all important components of this treatment.
2. Botulinum toxin (Botox®) treatment
- Botox injections are aimed at weakening the muscles that are overly tight or limiting the overall symmetrical movement of the face. The effect of the Botox wears off after around three months, so needs regular repeating.
3. Selective neurectomy and myectomy surgery
- This surgery is suitable for people who have facial synkinesis but are keen to explore a more permanent solution than that offered by Botox injections. It involves permanently dividing the small end branches of the facial nerve (neurectomy) that supply the muscles that are tight, over-active and limiting the overall movement of the face. In addition, it is often combined with dividing some of these muscles as well (myectomy).
- Typically, this is mostly used for treating the lower face and neck. In some cases, a neurectomy can be performed for treating the upper face, but there is a higher risk of causing excessive weakness around the eye in this case.