QUANTITATION OF PATTERNS OF FACIAL MOVEMENT IN PATIENTS WITH OCULAR TO ORAL SYNKINESIS

As patients with facial paralysis regain facial nerve function, they m ust endure and adapt to complications associated with recovery, such a s synkinesis. Synkinesis is the presence of unintentional movement in one area of the face when intentionally performing movement in another area of the face. We used the Maximal Static Response Assay of facial motion to better define the differences between eye closure-associate d perioral motion in normal individuals, motion of the affected side i n patients with synkinesis, and motion of the unaffected side in patie nts with synkinesis, thereby characterizing the syndrome of ocular to oral synkinesis. The study population consisted of 78 patients with cl inically defined ocular to oral synthesis of the left or right hemifac e and 27 individuals without facial impairment (control subjects). We used the Maximal Static Response Assay to quantify facial motion on th e affected and unaffected sides during the motions of eye closure and smile in both groups. Patients with ocular to oral synkinesis had decr eased supraorbital and infraorbital motion of the orbicularis oculi du ring eye closure on both the affected and unaffected sides relative to control subjects. They also had increased modiolar motion during eye closure on both sides relative to control subjects. On the affected si de, the modiolus tended to move laterally; on the unaffected side, the modiolus tended to move medially (i.e., toward the side affected by t he synkinesis). Modiolar motion present during eye closure in patients with ocular to oral synkinesis was not statistically different from m odiolar motion present during smile on the affected side (eye closure, 0.39 cm +/- 0.25; smile, 0.47 cm +/- 0.30, p > 0.05). Using the Maxim al Static Response Assay, we have quantitatively defined synkinesis of the affected hemiface and have shown that movement of the unaffected hemiface is influenced by the synkinetic movements of the affected hem iface. These data may provide the basis for a rational system of facia l neuromuscular rehabilitation in this patient group.