Q: Dr. Eppley, The onset of my Bell’s Palsy right side paralysis was four years ago. My case was severe, and it took many months to see small changes/progress. I have developed Synkenesis, which has caused pain and dimpling of my chin, pain and stiffness in my neck, especially the tendons on the affected side, and have been experiencing a general ache and or soreness, especially during these winter months, on many places on my face. I have not sought out treatment of these symptoms, until just now. I was chewing my food recently and the muscles in my neck involved in swallowing contracted repeatedly, thus, delaying my ability to swallow momentarily. It was quite frightening that this may actually cause me to choke if I don’t seek treatment. I am interested in Botox and,if possible, facial re-training as a treatment for my Synkenesis. Any advice or referral recommendations would be greatly appreciated. Thank you so much for taking the time to hear my case.
A: As you know, synkinesis is a common sequelae when the facial nerve fibers regenerate and start working again after any cause of paralysis. Synkinesis is the inability to coordinate various muscles on that affected side of the face. Unusual combinations of facial movements occur that were never present before the paralysis and have no functional reason for their occurrence.of half of the face. It results in a wide range of both functional and aesthetic changes. Common changes include narrowing of the eye during smiling, smile asymmetry, dimpling of the chin, asymmetry of the forehead an pulling sensations in the neck
Botox for facial synkinesis is an established treatment with proven effectiveness. But its role is most commonly done in the superficial face and platysmal neck muscles that are innervated by the seventh cranial nerve. I have treated such patients from facial nerve issues such as hemifacial spasm and at various period of recovery from facial nerve paralysis. The swallowing muscles are not, however, innervated by the seventh cranial nerves but by other motor nerves and I have no experience in treating those pharyngeal muscles by injection therapy. I am also uncertain that the swallowing sensations you have experienced are caused by muscles not innervated by the facial nerve.
Botox injections are used for two distinct effects…to either dampen down an overactive or spastic muscle or to weaken a normal acting one to help balance out certain facial expressions. It can be used to open a narrowed eye, soften the smile, and relieve the pulling sensation in the neck. It requires a careful assessment of the facial movements to determine the proper injection points so as to not cause additional facial asymmetry problems. This is of paramount importance around the eye area and injecting the orbicularis muscle.
Dr. Barry Eppley