Synkenesis?

[Machia2332]

Hi, I'm about 7 months post surgery for a 3.4 cm AN.  On the affected side my eye has recovered well and I've been doing exercises (for 7 months) to work on the facial muscle recovery.  While I have maybe 80% function again on the affected side, I've started having some synkenesis.  When I smile, the muscles near my eye on the affected side contract at the same time.  If I smile wide enough to show my teeth, the muscles in my neck contract on the affected side.  My physical therapist thinks developing the synkenesis is related to trying too hard with the exercises that other muscle groups are also activated.  I really don't think that is what is causing it.  Could this be a temporary sort of thing that is just part of the healing process for the facial nerve? 

Thanks,

Charles

[JLR]

Hi Charles, I'm 3 months post op. 2.7 AN retrosig. Have facial paralysis affected side. Right side. That is improving slowly. But my eye has not. Did you have eye problems that recovered? I'm not sure about your other issue. I'm fearful of having that so I try to do my Facial exercises slowly but there's no guarantee that I won't wind up with those muscle spasms. This whole surgery has been quite journey. Joan

[Machia2332]

I find that the recovery period takes the patience of a saint!  I either wore a moisture dome to bed or taped the eye shut for about 6 months. It gets a bit tiresome after a while.  I felt like the facial muscle recovery was a bit cosmetic compared to the eye dryness.  I've probably seen my eye dr 7 or 8 times in the past 6 months to keep checking on the condition of my eye on the affected side.  After about 6 months I seemed to be getting full closure of the eye, so I stopped taping it shut overnight.  I still put in some night time gel just to be safe, for now. Doing facial exercises for 7 months has also been an endurance challenge!  I would say to hang in there, it gets better.  My surgeon said that the facial nerve recovery will keep progressing until about a year post-surgery. 

[JLR]

Thanks Charles! I'm only 3 months post op so I'm hoping by month 6 I'm a lot better. My doctor wants to partially sew my lid so there's less exposure but I'm fighting that. This week I have no discomfort on the eye. Ointment every few hours and a moisture dome at night. Also switched ointment. Refresh Pm is 47% mineral oil and the balance petroleum as opposed to 15% mineral oil. Makes a huge difference. Joan

[Machia2332]

From what I understand, the brand of ointment could be better for some than others depending on your tear chemistry. I'm glad you found one that works for you. I didn't do so well with Refresh PM and had to switch.

[JLR]

Had 3 month post op MRI.  The 5% left on facial nerve is growing again. The surgeon wants me to consider radiation to stop the growth. I'm fearful of it giving me a set back since face paralysis is improving as well as the dry eye. Going to have 3 2nd opinions. Any thoughts? Thanks. Joan

[ANSydney]

My thoughts, rightly or wrongly, is establish the tumors growth profile over time. If your symptoms are acceptable and the tumor is less than 2 cm in maximum diameter - learn about its growth profile with time.

[JLR]

Thank you that's very helpful. Most appreciative. Joan

[mar]

Hi, I'm about 7 months post surgery for a 3.4 cm AN.  On the affected side my eye has recovered well and I've been doing exercises (for 7 months) to work on the facial muscle recovery.  While I have maybe 80% function again on the affected side, I've started having some synkenesis.  When I smile, the muscles near my eye on the affected side contract at the same time.  If I smile wide enough to show my teeth, the muscles in my neck contract on the affected side.  My physical therapist thinks developing the synkenesis is related to trying too hard with the exercises that other muscle groups are also activated.  I really don't think that is what is causing it.  Could this be a temporary sort of thing that is just part of the healing process for the facial nerve? 

Thanks,

Charles

I started having synkinesis with my eyebrow and smile muscles. My eyebrow raises when I smile very hard, and the right side of my mouth and nose tense up when I raise my brow. My PT told me the same thing yours told you, namely, that I am trying too hard to move my face and this is causing the synkinesis. My neck muscles never came back like my facial muscles and I deal with neck and shoulder pain because of it. But I am in rehab to try to strengthen my neck currently.

Since I still have some synkinesis (especially when I'm actively trying to move my facial muscles) I can't offer much advice, but the way to break synkinesis is to try to relax one muscle group while engaging the other. This gets easier with practice.

[caryawilson]

Let me take a stab here. 

Medically I would love to know why these synkenesis symptoms occur. As you noted, a large smile would close the eyes. I believe I understand the nerve signaling but not the cause. For example, the facial nerve has five branches for the eye, forehead, neck, mouth, and cheek (I think). The facial nucleus in the brain stem is responsible for coordinating which fibers fire. It's basically a single nerve (facial nerve) with thousands of nerve fibers which are controlled by the nucleus via the five branches. Having greater control of these fibers is why some people can raise eyebrows, nose flairs, etc. This is not identical for all people, hence some people may naturally close their eyes when they smile. I can easily understand how the eyes will close, during a smile or for that matter how the neck muscles will tighten. I would think this is because the facial nucleus is firing the nerves and when you are forcing the motion the brain is more confused so it send more nerve signals. However, why is the brain stem firing these extra nerve fibers? Trying hard, makes some sense. Think about a normal person that tries to force a huge smile. Normally this person's eyes would start to close.  In the case of Charles, as he tries to force a larger and larger smile, eventually the neck muscles tighten. This would makes as much sense as the eye, since the eye, smile and neck are controlled by the facial nerve.  I have NOT seen a medical journal on this topic. They discuss how Botox could be used to dull the firing of these extra fibers (same procedure to get rid of wrinkles) but it's unclear why the brain stem is firing them in the first place.

In my case, my masseter nerve was grafted to my facial nerve and the brow and neck branches were disconnected. Hence, tightening my jaw will create a smile and start to close the eye. As expected.  However,. The group that has a weekend facial nerve, the firing of the nerve fibers is either by the brain stem, or firing on their own.

Interesting. Thoughts?

[ccooper]

I'm a year post surgery for a very large AN on my right side with facial paralysis. I too have recovered well but probably just 60%. I have the opposite of you. When I try and close my eye, my right side tries to smile. It actually meant my cheek was contracted all the time and it started to get painful. I actually stopped trying to close my eye. My PT (Jackie Diehls) has me closing my eye (which means my cheek contracts) and once it's closed focus on relaxing my cheek. Best of luck to you. 

[Soundy]

Nine years, 10 months and 8 days out from trans lab. AN eye closes from yawning, big smile or for the neck of it. AN side mouth doesn't come up as it should. And tongue doesn't follow commands. Do exercises when no ones watching that Sen to help. When overtired symptoms are worse. What my grandaughter has termed my dull face, as in not smiling just relaxed,  my mouth and eye look normal. I don't do pictures because I smile and look like I'm making faces or relax and look like I'm at a funeral. And for the record my kids and brands prefer my wonky face. My granddaughter  (8 yrs) told me I needed to do some pictures so if I die she can remember what I look like. Doctors don't seem to under stand the pain and depression that can come from the altered state of our faces.