Facial Synkinesis | Otolaryngology (ENT) | Loyola Medicine

Facial Synkinesis

Overview and Facts about Facial Synkinesis

Facial synkinesis refers to inappropriate and unintended muscle movements in the face with certain voluntary facial expressions. This is a phenomenon that occurs after a facial nerve injury of some nature. Synkinesis occurs as the nerve is attempting to recover and as a result, there is miswiring of the facial branches. This can occur after any kind of nerve insult including Bell’s palsy, Ramsay Hunt syndrome, or facial trauma. Patients with synkinesis will notice movements such as mouth or chin twitching with eye closure, squinting with smiling, or neck contracture with smiling.  

Symptoms and Signs of Facial Synkinesis

After facial nerve injury, there are several facial patterns and associated movements that may indicate synkinesis. These patterns include:

  • Squinting with smiling
  • Difficulty smiling
  • Chin dimpling
  • Mouth or chin twitching with eye closure
  • Tightness in the cheeks or neck with smiling
  • Narrowing of the eyes 

Causes and Risk Factors of Facial Synkinesis

Synkinesis is caused by trauma to the facial nerve. Trauma can occur due to direct injury, inflammation of the facial nerve or viral infection (such as Ramsay Hunt syndrome). 

Tests and Diagnosis of Facial Synkinesis

Your doctor will be able to visually assess your symptoms to determine if you have facial synkinesis. He/she will also conduct a thorough physical exam and review your medical history to check if you have had facial nerve injury, Bell’s palsy or Ramsay Hunt syndrome

Treatment and Care for Facial Synkinesis

Synkinesis can be effectively treated in a variety of ways. Neuromuscular retraining is a valuable part of rehabilitation for facial paralysis, which can help to restore function and control inappropriate facial movements (synkinesis).

At Loyola, we have physical therapists and occupational therapists with specialized training in helping patients with facial nerve injury. Synkinesis can also be effectively treated with Botox injections to help control the unintended movements.  These two treatments are especially effective when used in conjunction with one another.