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Iran J Otorhinolaryngol. 2015 Nov;27(83):409-15.

Management of Facial Synkinesis with a Combination of BTX-A and Biofeedback: A Randomized Trial.

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Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.



Synkinesis and facial asymmetry due to facial nerve palsy are distressing conditions that affect quality of life. Unfortunately, these sequelae of facial nerve palsy are unresolved. The aim of this study was to investigate the efficacy of a combination of biofeedback therapy and botulinum toxin A (BTX-A) injection for the management of synkinesis and asymmetry of facial muscles.


Among referrals from three university hospitals, 34 patients with facial synkinesis were divided randomly into two groups. All participants were evaluated using Photoshop software, videotape, and facial grading system (FGS). The first group received a single dose of BTX-A at the start of treatment, while the second group received normal saline as a control. Both groups received electromyography (EMG) biofeedback three times a week for 4 months.


The mean FGS values for the BTX group before and after treatment were 55.17 and 74.17, respectively, and those for the biofeedback group were 66.31 and 81.37, respectively. Moreover, it was shown that in both groups oral-ocular and oculo-oral synkinesis decreased significantly after treatment compared with before treatment (P<0.01).When these measurements were performed using Photoshop and videotape, these differences were even greater. Despite the decrease in synkinesis in both groups after treatment, there were no significant differences between the two treatment groups (P>0.05).


Biofeedback therapy is as effective as the combination of biofeedback and BTX in reducing synkinesis and recovery of facial symmetry in Bell's palsy.


Bell's palsy; Biofeedback; Botulinum toxin; Synkinesis


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