Management of Synkinesis and Asymmetry in Facial Nerve Palsy: A Review Article

Document Type: Systematic Review


Department of Physiotherapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.


The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy.
Materials and Methods:
Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013.
Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education.
Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.


1. Pereira LM. Facial exercise therapy for facial palsy: systematic review and meta-analysis. Clin Rehabil 2011; 25(25): 649–58.

2. Beurskens CH, Heymans PG. Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial. Australian J Physiother 2006; 52(3): 177–83.

3. Ma MS, Van der Hoeven JH, Nicolai JPA, Meek MF. Sound-induced facial synkinesis following facial nerve paralysis. Plast Reconstr  Aesthet  Surg 2009; 62(8): 1025–9.

4. Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl.2002;122(7),         4–30.

5. Beurskens CH, Heymans PG. Positive effects of mime therapy on sequelae of facial paralysis: stiffness, lip mobility, and social and physical aspects of facial disability. Otology & Neurotology 2003; 24(4): 677–81.

6. Cronin GW, Steenerson RL. The effectiveness of neuromuscular facial retraining combined with electromyography in facial paralysis rehabilitation. Otolaryngology - Head & Neck Surgery 2003; 128(4):534–8.

 7. Pepper J-P. Selective chemodenervation with botulinum toxin in facial nerve disorders. Operative Techniques. Otolaryngology-Head and Neck Surgery 2012; 23(4): 297–305.

8. Yamamoto E, Nishimura H, HironoY. Occurrence of sequelae in Bell’s palsy. Acta Otolaryngol 1987; 446:93-6.

9. Celik M, Forta H, Vural C. The development of synkinesis after facial nerve paralysis. European Neurology 2000; 43(3): 147–51.

10. Nakamura K, Toda N, Sakamaki K, Kashima K, Takeda N. Biofeedback rehabilitation for prevention of synkinesis after facial palsy. Otolaryngology - Head and Neck Surgery 2003; 128(4): 539–43.

11. Terzis JK KD. Therapeutic strategies in post-facial paralysis synkinesis in pediatric patients. J Plas Reconstruct Aesthet Surg 2012.

12. Kimura J RROSH. Electrophysiologic analysis of aberrant regeneration after facial nerve paralysis. Neurology 1975; 25(10): 989–93.

13. Rahman I SSA. Ophthalmic Management of Facial Nerve Palsy: A Review. Surv Ophthalmol 2007; 52(2): 121–44.

14. May M. Management of facial hyperkine- sis,overview of hyperkinesis. The facial nerve. New York; 2000. p. 431–39.

15. Pourmomeny AA, Asadi S.  Facial  Rehabilitation.Physical Treatments Specific Physical Therapy Journal. In press 2014.

16.    Pourmomeny AA, Zadmeher H, Mirshamsi M, Mahmodi Z. Prevention of synkinesis by biofeedback therapy: A randomized clinical trial. Otology and Neurotology. In press 2013.

17. Dalla Toffola E, Tinelli C,  Lozza A, Bejor M, Pavese C, Degli Agosti I, et al. Choosing thr best rehabilitation treatment for Bell's palsy. Eur J phys Rehabil Med 2012; 48(4): 635–42.

18. Ross Brenda, Julian M,  Efficacy of feedback training in long-standing facial nerve paresis. Laryngoscope 1991;101(7): 744–50.

19.  Dalla Toffola E. Usefulness of BFB/EMG in facial palsy rehabilitation. Disabil Rehabil 2005; 22(14): 809–15.

20.    VanSwearingen Jessie. Facial Rehabilitation: A Neuromuscular Reeducation, Patient-Centered Approach Jessie. Facial Plastic Surgery 2008;24 (2): 250–9.

21. Brodal A. Neurological Anatomy in Relation to Clinical Medicine. 3rd ed. New York: Oxford University Press; 1981.