Timing of Treatment Initiation and Effect on Facial Synkinesis Outcomes-A Retrospective Study.

Background: While facial neuromuscular retraining and chemodenervation are effective treatments for facial synkinesis, it is unclear if clinical outcomes are affected by the timing or sequence of treatment initiation. Objective: To compare outcomes between patients with facial synkinesis based on timing of treatment initiation with facial neuromuscular retraining and/or chemodenervation as measured by the Sunnybrook Facial Grading System. Methods: Retrospective review of patients with facial synkinesis. Patient data recorded include demographics, clinical information, and Sunnybrook scores. t-Tests, analysis of variance, and logistic regression were used for analysis. Results: A total of 78 adult patients were included in our study (73% female; median age 50 years with a range of 18-78 years). Median patient follow-up was 16 months (range of 1-56 months). Patients were divided into three groups based on time between paralysis onset and treatment initiation: <12 months, 12-36 months, and >36 months. The use of facial neuromuscular retraining and chemodenervation improved Sunnybrook scores for all patients. The time between paralysis onset to treatment initiation was not associated with a difference in Sunnybrook scores. Conclusion: The duration of facial palsy prior to initiation of facial neuromuscular retraining and/or chemodenervation was not associated with a difference in synkinesis outcomes as determined by Sunnybrook scores.