Mirror biofeedback rehabilitation after administration of single-dose botulinum toxin for treatment of facial synkinesis

• Published in: Otolaryngology-head and neck surgery Vol. 146; no. 1; p. 40
• Main Authors: Azuma, Takahiro, Nakamura, Katsuhiko, Takahashi, Mika, Ohyama, Seizo, Toda, Naoki, Iwasaki, Hidetaka, Kalubi, Bukasa, Takeda, Noriaki
• Format: Journal Article
• Language: English
• Published: England 01.01.2012
• Subjects: Adult; Aged; Biofeedback, Psychology - drug effects; Botulinum Toxins, Type A - administration & dosage; Chronic Disease; Dose-Response Relationship, Drug; Face; Facial Muscles - physiopathology; Facial Paralysis - complications; Facial Paralysis - drug therapy; Facial Paralysis - physiopathology; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Middle Aged; Muscle Contraction - drug effects; Muscle Contraction - physiology; Neuromuscular Agents - administration & dosage; Prospective Studies; Synkinesis - drug therapy; Synkinesis - etiology; Synkinesis - physiopathology; Treatment Outcome
• ISSN: 1097-6817
• DOI: 10.1177/0194599811424125

The efficacy of facial biofeedback rehabilitation with a mirror after administration of a single dose of botulinum A toxin on facial synkinesis was examined in patients with chronic facial palsy. Prospective clinical study. University hospital. The present study includes 8 patients with Bell palsy and 5 with herpes zoster oticus showing facial synkinesis. A single dose of botulinum A toxin was used as the initial process of facial rehabilitation. Patients then continued a daily facial biofeedback rehabilitation with a mirror at home. They were instructed to keep their eyes symmetrically open using a mirror during mouth movements. The degree of oral-ocular synkinesis was evaluated by the degree of asymmetry of eye opening width during mouth movements (% eye opening). After administration of a single dose of botulinum A toxin, temporary relief of facial synkinesis was observed in all patients. Patients were then instructed to continue the facial biofeedback rehabilitation with a mirror for 10 months. The mean values of the percent of eye opening during 3 designated mouth movements that included lip pursing /u:/, teeth baring /i:/, and cheek puffing /pu:/ increased significantly after 10 months when the effects of botulinum A toxin had completely disappeared. These findings demonstrate that facial biofeedback rehabilitation with a mirror after administration of a single dose of botulinum A toxin is a long-lasting treatment of established facial synkinesis in patients with chronic facial palsy.