Causes of Facial Synkinesis with Dr. Amer, Professor of Plastic and Microsurgery

Facial synkinesis is the involuntary movement of facial muscles during voluntary facial actions. For example, when a patient attempts to smile, the eye may close unintentionally. This occurs because of abnormal nerve regeneration following facial nerve injury.

Learn more about facial paralysis

The facial nerve (cranial nerve VII) is a highly complex structure controlling:

• Facial expressions (smile, frown, blinking)

• Lacrimal (tear) gland secretion

• Taste in part of the tongue

• Salivary gland function

Any injury to this delicate nerve may cause paralysis, weakness, or abnormal regeneration, leading to synkinesis.

Bell’s Palsy and Misguided Nerve Regeneration

Bell’s palsy, a sudden paralysis of facial muscles due to inflammation of the facial nerve, is one of the most common causes. During nerve healing, fibers may regenerate abnormally, causing miswiring and unwanted simultaneous contractions.

Traumatic Facial Nerve Injury

Car accidents, penetrating injuries, or blunt trauma can damage the nerve. Misaligned healing after trauma is a major trigger for synkinesis.

Surgical Complications

• Acoustic neuroma surgery

• Parotid gland tumor excision

• Skull base surgery

All may inadvertently damage or compress the facial nerve.

Tumors and Facial Nerve Compression

Benign or malignant tumors near the facial nerve can cause pressure-induced damage, leading to abnormal regrowth.

Congenital Causes

Rarely, congenital abnormalities in nerve pathways can lead to synkinesis present from birth.

• Aberrant regeneration: Nerve fibers grow into unintended pathways.

• Axonal misrouting: Fibers for one muscle mistakenly connect to another.

• Hyperexcitability of motor neurons: Overactive nerve signaling.

This explains why smiling may trigger eye closure or why blinking may activate mouth movements.

Patients often notice:

• Involuntary eye closure during smiling

• Mouth movement during blinking

• Tension and tightness in facial muscles

• Difficulty in emotional expression

• Facial asymmetry

Facial synkinesis is not merely cosmetic. Patients report:

• Anxiety and depression

• Social withdrawal

• Loss of self-confidence

• Impaired professional interactions

• Clinical examination (observing involuntary movements)

• Electromyography (EMG)

• Video analysis for subtle patterns

Non-Surgical Management

• Botulinum toxin (Botox): Relieves tightness and reduces involuntary movements

• Physical therapy: Retrains coordinated movements

• Mirror biofeedback therapy

Surgical Management

• Selective neurolysis

• Nerve grafting

• Muscle transfer for severe cases

Rehabilitation and Physical Therapy

A cornerstone in long-term management:

• Stretching

• Neuromuscular re-education

• Breathing exercises

Dr. Amer is internationally recognized for:

• Advanced microsurgical nerve repair

• Facial reanimation surgery

• Botulinum toxin protocols tailored for synkinesis

• Holistic patient-centered care

At Dr. Tarek Amer’s clinic, patients find:

• Psychological counseling

• Peer support groups

• Long-term rehabilitation programs