Synkinesis: Difference between revisions
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The unintentional or mass movements are thought to be caused by an undifferentiated regeneration of the facial nerve that occurs after being compressed or damaged.<br> | The unintentional or mass movements are thought to be caused by an undifferentiated regeneration of the facial nerve that occurs after being compressed or damaged.<br> | ||
There are 3 possible mechanisms which it is thought could be the cause of synkinesis: | There are 3 possible mechanisms which it is thought could be the cause of synkinesis: | ||
#Aberrant regeneration | #Aberrant regeneration | ||
#Ephaptic transmission | #Ephaptic transmission | ||
#Nuclear hyperexcitability | #Nuclear hyperexcitability | ||
It is possible that a combination of 2 or all 3 of these mechanisms is involved. | It is possible that a combination of 2 or all 3 of these mechanisms is involved. | ||
== Clinical Presentation == | == Clinical Presentation == | ||
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Following flaccid facial palsy, as the patient experiences recovery and reinnervation of the affected side of the face, they also experience the involuntary linking of movements which are typical of synkinesis. | Following flaccid facial palsy, as the patient experiences recovery and reinnervation of the affected side of the face, they also experience the involuntary linking of movements which are typical of synkinesis. | ||
The effects which are most commonly observed are: | The effects which are most commonly observed are: | ||
*when moving the mouth (eg. smile, lip pucker, when eating) the eye on the affected side moves towards partial (or occasionally full) closure, whereas the unaffected eye remains wide open | *when moving the mouth (eg. smile, lip pucker, when eating) the eye on the affected side moves towards partial (or occasionally full) closure, whereas the unaffected eye remains wide open | ||
*when raising the eyebrows or closing the eyes, the corner of the mouth on the affected side of the face raises | *when raising the eyebrows or closing the eyes, the corner of the mouth on the affected side of the face raises<br> | ||
== | == Scoring/measuring synkinesis == | ||
The most commonly (by surgeons and physicians) used measure of facial range of movement is the [[House–Brackmann_Scale|House-Brackmann]] scale<ref>House JW, Brackmann DE (1985). "Facial nerve grading system". Otolaryngol Head Neck Surg 93: 146–147</ref>. | |||
Unfortunately, this does not have a rating for the aberrant linking of movements which occur in synkinesis. | |||
The Sunnybrook Facial Grading System<ref>Otolaryngol Head Neck Surg. 1996 Mar;114(3):380-6. | |||
Development of a sensitive clinical facial grading system. | |||
Ross BG1, Fradet G, Nedzelski JM.</ref> is a more comprehensive scoring system for facial range of movement, has a section dedicated to rating the presence of synkinesis movements<ref>Laryngoscope. 2010 May;120(5):1038-45. doi: 10.1002/lary.20868. | |||
Sunnybrook facial grading system: reliability and criteria for grading. | |||
Neely JG1, Cherian NG, Dickerson CB, Nedzelski JM</ref>. | |||
== Management / Interventions<br> == | == Management / Interventions<br> == | ||
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== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
Synkinesis is a clinical diagnosis, and is usually easy to diagnose as the patient will demonstrate clear linking of facial movements on the affected side only and will have a history of facial palsy.<br> | |||
== Resources <br> == | == Resources <br> == | ||
The Facial Palsy UK charity has a comprehensive website, and [http://www.facialpalsy.org.uk/advice/guides/synkinesis/230 this is the page] explaining moe about synkinesis. | The Facial Palsy UK charity has a comprehensive website, and [http://www.facialpalsy.org.uk/advice/guides/synkinesis/230 this is the page] explaining moe about synkinesis. | ||
== Case Studies == | == Case Studies == | ||
Revision as of 21:27, 28 July 2014
Original Editor - Wendy Walker
Lead Editors
Introduction & Definition[edit | edit source]
Synkinesis (AKA aberrant regeneration) occurs after injury to the facial nerve, as a common sequelae of facial palsy.
The cause of the injury may be simple Bell's Palsy, the less common condition Ramsey Hunt Syndrome, surgical damage (eg. during surgical removal of Acoustic Neuroma) or trauma (skull fractures).
Synkinesis = "syn" meaning "together and "kinesis" meaning movement. Therefore synkinesis means "moving together" or "mass movement".
Synkinesis is an involuntary movement accompanying a voluntary one. These unintentional movements are thought to be caused by an undifferentiated regeneration of the facial nerve that occurs after being compressed or damaged.
Clinically Relevant Anatomy
[edit | edit source]
The facial nerve is the 7th cranial nerve, and it controls the muscles of facial expression.
Refer to the Facial Nerve page for more details of its anatomy.
Mechanism of Injury / Pathological Process
[edit | edit source]
The unintentional or mass movements are thought to be caused by an undifferentiated regeneration of the facial nerve that occurs after being compressed or damaged.
There are 3 possible mechanisms which it is thought could be the cause of synkinesis:
- Aberrant regeneration
- Ephaptic transmission
- Nuclear hyperexcitability
It is possible that a combination of 2 or all 3 of these mechanisms is involved.
Clinical Presentation[edit | edit source]
Following flaccid facial palsy, as the patient experiences recovery and reinnervation of the affected side of the face, they also experience the involuntary linking of movements which are typical of synkinesis.
The effects which are most commonly observed are:
- when moving the mouth (eg. smile, lip pucker, when eating) the eye on the affected side moves towards partial (or occasionally full) closure, whereas the unaffected eye remains wide open
- when raising the eyebrows or closing the eyes, the corner of the mouth on the affected side of the face raises
Scoring/measuring synkinesis[edit | edit source]
The most commonly (by surgeons and physicians) used measure of facial range of movement is the House-Brackmann scale[1].
Unfortunately, this does not have a rating for the aberrant linking of movements which occur in synkinesis.
The Sunnybrook Facial Grading System[2] is a more comprehensive scoring system for facial range of movement, has a section dedicated to rating the presence of synkinesis movements[3].
Management / Interventions
[edit | edit source]
add text here relating to management approaches to the condition
Differential Diagnosis
[edit | edit source]
Synkinesis is a clinical diagnosis, and is usually easy to diagnose as the patient will demonstrate clear linking of facial movements on the affected side only and will have a history of facial palsy.
Resources
[edit | edit source]
The Facial Palsy UK charity has a comprehensive website, and this is the page explaining moe about synkinesis.
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ House JW, Brackmann DE (1985). "Facial nerve grading system". Otolaryngol Head Neck Surg 93: 146–147
- ↑ Otolaryngol Head Neck Surg. 1996 Mar;114(3):380-6. Development of a sensitive clinical facial grading system. Ross BG1, Fradet G, Nedzelski JM.
- ↑ Laryngoscope. 2010 May;120(5):1038-45. doi: 10.1002/lary.20868. Sunnybrook facial grading system: reliability and criteria for grading. Neely JG1, Cherian NG, Dickerson CB, Nedzelski JM
