Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.
Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Facial Plast Surg. 2024 Aug;40(4):514-524. doi: 10.1055/a-2305-2007. Epub 2024 Apr 11.
Postparalysis facial synkinesis (PPFS) can develop in any facial palsy and is associated with significant functional and psychosocial consequences for affected patients. While the prevention of synkinesis especially after Bell's palsy has been well examined, much less evidence exists regarding the management of patients with already established synkinesis. Therefore, the purpose of this review is to summarize the available literature and to provide an overview of the current therapeutic options for facial palsy patients with established synkinesis. A systematic literature review was undertaken, following the Preferred Reporting Items of Systematic Reviews and Meta-analyses 2020 guidelines. MEDLINE via PubMed and Cochrane Library were searched using the following strategy: ([facial palsy] OR [facial paralysis] OR [facial paresis]) AND (synkinesis) AND ([management] OR [guidelines] OR [treatment]). The initial search yielded 201 articles of which 36 original papers and 2 meta-analyses met the criteria for inclusion. Overall, the included articles provided original outcome data on 1,408 patients. Articles were divided into the following treatment categories: chemodenervation (12 studies, 536 patients), facial therapy (5 studies, 206 patients), surgical (10 studies, 389 patients), and combination therapy (9 studies, 278 patients). Results are analyzed and discussed accordingly. Significant heterogeneity in study population and design, lack of control groups, differences in postoperative follow-up, as well as the use of a variety of subjective and objective assessment tools to quantify synkinesis prevent direct comparison between treatment modalities. To date, there is no consensus on how PPFS is best treated. The lack of comparative studies and standardized outcome reporting hinder our understanding of this complex condition. Until higher quality scientific evidence is available, it remains a challenge best approached in an interdisciplinary team. An individualized multimodal therapeutic concept consisting of facial therapy, chemodenervation, and surgery should be tailored to meet the specific needs of the patient.
面瘫后面部联动（PPFS）可发生于任何面瘫，并与受影响患者的显著功能和心理社会后果相关。虽然对面瘫，特别是贝尔面瘫后联动的预防已经进行了充分的研究，但对于已经存在联动的患者的管理，证据则要少得多。因此，本综述的目的是总结现有文献，并概述已确立联动的面瘫患者的当前治疗选择。按照 2020 年系统评价和荟萃分析的首选报告项目指南，进行了系统的文献综述。通过 MEDLINE 上的 PubMed 和 Cochrane Library，使用以下策略进行了搜索：（[面瘫]或[面瘫]或[面肌无力]）和（联动）和（[管理]或[指南]或[治疗]）。最初的搜索产生了 201 篇文章，其中 36 篇原始论文和 2 篇荟萃分析符合纳入标准。总体而言，纳入的文章提供了 1408 名患者的原始结果数据。文章分为以下治疗类别：化学神经切断术（12 项研究，536 名患者）、面部治疗（5 项研究，206 名患者）、手术（10 项研究，389 名患者）和联合治疗（9 项研究，278 名患者）。相应地分析和讨论了结果。研究人群和设计的显著异质性、缺乏对照组、术后随访的差异以及各种主观和客观评估工具的使用，以量化联动，防止了治疗方式之间的直接比较。迄今为止，对于如何最好地治疗 PPFS 尚无共识。缺乏比较研究和标准化的结果报告，阻碍了我们对这种复杂疾病的理解。在有更高质量的科学证据之前，这仍然是一个挑战，最好在跨学科团队中解决。由面部治疗、化学神经切断术和手术组成的个体化多模式治疗方案应根据患者的具体需求进行定制。
