Chemodenervation of the Posterior Belly of the Digastric Muscle in Facial Synkinesis

• Published in: Archives of facial plastic surgery Vol. 25; no. 5; p. 378
• Main Authors: Longino, Elizabeth S, Davis, Seth J, Landeen, Kelly C, Kimura, Kyle S, Sharma, Rahul K, Ortiz, Alexandra S, Yang, Shiayin F, Patel, Priyesh N, Stephan, Scott J
• Format: Journal Article
• Language: English
• Published: Chicago American Medical Association 01.10.2023
• Subjects: Botulinum toxin; Discomfort; Electromyography; Injection; Jaw; Muscles; Tightness; Toxins
• ISSN: 2168-6076; 2168-6092
• DOI: 10.1089/fpsam.2022.0207

Background: Patients with facial synkinesis may have jaw tightness and swallow discomfort despite chemodenervation of facial mimetic musculature, and the posterior belly of the digastric (PBD) muscle is a logical target to treat these symptoms. Learning/Study Objective: To compare patient-reported outcomes of botulinum toxin (BT) chemodenervation of the posterior belly of digastric muscle in patients with postparalytic facial synkinesis. Design Type: Retrospective review. Methods: Patients with facial synkinesis who underwent electromyography (EMG)-guided PBD BT chemodenervation in addition to their baseline therapeutic regimen were included. Pre- and post-treatment Synkinesis Assessment Questionnaires (SAQ) and a two-question survey regarding jaw tightness and swallow discomfort were administered. Results: Twenty-nine patients were included. An average of 5 U of BT-A was injected into the PBD, and 46.5 U across all facial muscles. From pre- to post-injection, patients demonstrated improvement in jaw tightness at rest (3.02 vs. 1.98/5.0, p < 0.001), with swallow (2.78 vs. 1.94/5.0, p < 0.001), and total SAQ (64.3 vs. 51.2/100, p < 0.001). Patients rated subjective benefit from PBD injection compared with prior treatments without PBD injection as 4.5/5.0. Conclusion: Synkinesis patients with jaw tightness or swallow discomfort may benefit from the addition of PBD injections to the therapeutic regimen.