Comprehensive Rehabilitation of Patients with Facial Expression Asymmetry and Synkinesis with Botulinum Toxin Type A and Monofilament Mesothreads

Abstract

Facial neuropathy is a lesion of the facial nerve of various nature happening at different anatomical levels, which is manifested by unilateral paralysis or paresis of the facial muscles and is complicated by synkinesis and contractures of the paretic muscles. The leading clinical symptom of this disorder is mimic asymmetry, which occurs as a result of a violation of the neuromuscular balance of both hemifaces (weakness on the side of the lesion and hypertonicity on the contralateral side). Understanding the special functional state of the unaffected hemiface made it possible to develop a pathogenetically substantiated method for the treatment of mimic asymmetry. The effect of botulinum toxin type A on the muscles of the healthy hemiface contributes to a better restoration of the motor activity of the affected muscles and the symmetry of the face. Implantation of monofilament mesothreads in the facial area was used to correct synkinesis. We have proposed a method that creates a rigid mesh frame using mesothreads between the skin and the muscles of facial expression in the area of synkinesis. This led to a significant decrease in the severity of clinical symptoms, a decrease in the frequency and amplitude of involuntary muscle contractions in the face.