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Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
From a prognostic standpoint, the amplitude of the facial motor response on electrodiagnostic testing can be helpful in the case of a unilateral facial palsy, by comparing side-to-side amplitude difference 5–7 days after onset of symptoms. On rare occasions, recovery from Bell's palsy may be associated with persistent dysfunction including synkinesis, myokymia, or hemifacial spasm.35
Histories and examinations in the Part 2 clinical section
Published in Joseph Manjaly, Peter Kullar, Advanced ENT Training, 2019
To test CN7, ask the patient to blink rapidly, this is a more sensitive test than testing the power of eye closure. Even a subtle loss will cause detectable delayed blink in one eyelid compared to the other. This will also test for synkinesis, watch the angle of the mouth for this during blinking. Also test power by trying to forcibly open eyes closed ‘as tightly as you can’. Ask the patient to smile and check for symmetry.
Head and neck
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Although the results can be rather unpredictable, 80% have good results with intensive physiotherapy and training. There is a tendency for synkinesis or, occasionally, hypertonia. As such, crossovers are generally reserved for those not suitable for CFNG, e.g. for older patients.
Congenital trochlear-oculomotor synkinesis with ptosis
Published in Clinical and Experimental Optometry, 2023
Maxence Rateaux, Romain Touze, Dominique Bremond-Gignac
Synkinesis is described as an aberrant innervation of a muscle by a nerve not originally destined to this muscle. One of the most common is the trigemino-oculomotor synkinesis (i.e. the Marcus-Gunn syndrome) although several types of oculomotor synkinesis were reported in the literature, as the aberrant innervation of the lateral rectus by elevator fibres.6,7 The trochlear-oculomotor synkinesis (TOS) is characterised by an abnormal retraction of the upper eyelid in the down and adduction gaze, corresponding to the action field of the superior oblique muscle. The TOS is probably explained by an aberrant innervation of the levator palpebrae (normally innervated by the upper division of the IIIrd cranial nerve) by the IVth cranial nerve, according to the close relation between both nerves at the orbital apex.4 In this oculomotor synkinesis, the presence of a congenital ptosis asserts the hypothesis of an aberrant innervation of the levator palpebrae by the IVth cranial nerve.
Therapists’ perceptions and attitudes in facial palsy rehabilitation therapy: A mixed methods study
Published in Physiotherapy Theory and Practice, 2022
Martinus M. van Veen, Britt W.T ten Hoope, Tessa E. Bruins, Roy E. Stewart, Paul M.N. Werker, Pieter U. Dijkstra
The largest group of patients treated by the therapists consisted of patients with synkinesis or at risk of developing synkinesis, most of whom suffered from Bell’s palsy. These patients also have the most to gain from mime therapy because it requires at least some movement of the facial muscles in order to be possible. In contrast, patients with chronic flaccid paralysis have much less to gain from mime therapy because there is no existing movement to strengthen or alter. Some mime therapists also treated facial palsy patients after smile reanimation surgery. These mime therapists expressed the belief that mime therapy is essential for all patients who undergo smile reanimation surgery. “If there is no movement at all you can’t really do anything. Well, except for providing some tips and tricks on how to deal with more practical issues such as drooling or spill of food when eating.”
Long-term surgical outcomes of levator resection in patients with Marcus-Gunn jaw-winking ptosis
Published in Orbit, 2022
Rakan S. Al-Essa, Rawan N. Althaqib, Don O. Kikkawa, Adel H. Alsuhaibani
Surgical management of MGJWS is controversial. In MGJWS, surgical intervention is indicated when the ptosis or jaw winking is cosmetically significant or causing amblyopia. Several surgical techniques are available in the literature and the surgical option of choice depends mainly on the degree of ptosis, severity of jaw winking and patient or family preference. In cases of ptosis not causing amblyopia, the patient can be observed with decisions about cosmetic correction being deferred. Patients with jaw winking may learn specific jaw positions to minimize the ptosis and abnormal movements (habitual ptosis phenomenon).24 Thus, symptoms of mild synkinesis can be controlled naturally by the patient without the need for surgical intervention. In cases of marked jaw winking or severe ptosis with poor levator function, bilateral levator muscle disinsertion with bilateral frontalis suspension (Beard procedure) or unilateral levator muscle disinsertion of the involved side with bilateral frontalis suspension (Callahan procedure) is considered the procedure of choice for many surgeons.14,15