Pathogenesis, diagnosis and therapy of facial synkinesis: A systematic review and clinical practice recommendations by the international head and neck scientific group.

Autor:	Guntinas-Lichius O; Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.; Facial Nerve Center, Jena University Hospital, Jena, Germany.; Multidisciplinary Salivary Gland Society, Geneva, Switzerland., Prengel J; Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.; Facial Nerve Center, Jena University Hospital, Jena, Germany., Cohen O; Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Affiliated With Ben-Gurion University of the Negev, Be'er Sheva, Israel., Mäkitie AA; Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland., Vander Poorten V; Multidisciplinary Salivary Gland Society, Geneva, Switzerland.; Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.; Otorhinolaryngology, Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium., Ronen O; Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Affiliated With Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel., Shaha A; Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States., Ferlito A; International Head and Neck Scientific Group, Padua, Italy.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2022 Nov 09; Vol. 13, pp. 1019554. Date of Electronic Publication: 2022 Nov 09 (Print Publication: 2022).
DOI:	10.3389/fneur.2022.1019554
Abstrakt:	Introduction: Post-paralytic facial synkinesis after facial nerve injury produces functional disabilities and mimetic deficits, but also cosmetic and non-motor psychosocial impairments for the patients. These patients typically have a high and continuous high motivation for rehabilitation. The aim is to inform the affected patients and their therapeutic professionals (otorhinolaryngologist - head and neck surgeons; oral-maxillofacial surgeons, plastic and reconstructive surgeons, neurosurgeons, neurologists, and mime therapists be it speech and language therapy- or physiotherapy-based) and to provide practical recommendations for diagnostics and a stepwise systematic treatment approach of facial synkinesis. Methods: In the first phase, a systematic literature search on the topic in PubMed and ScienceDirect starting in 2008 resulted in 132 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostic tests and treatment options. In the second phase, one consensus article circulated among the membership of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations. Results: Diagnostics should include a standardized assessment of the degree of synkinesis using validated clinician-graded instruments and synkinesis-specific patient-reported outcome measures. Treatments for facial synkinesis include facial training mainly based on facial biofeedback retraining, chemodenervation with botulinum toxin, selective neurectomy, myectomy, and any combination treatment of these options. Conclusion: A basic understanding of the pathomechanisms of synkinesis is essential to understand the treatment strategies. A standardized assessment of the synkinetic symptoms and the individual synkinesis pattern is needed. The first-line treatment is facial training, followed by botulinum toxin. Surgery is reserved for individual cases with unsatisfactory first-line treatment. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Guntinas-Lichius, Prengel, Cohen, Mäkitie, Vander Poorten, Ronen, Shaha and Ferlito.)
Databáze:	MEDLINE
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