synkinesis.

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Introduction and Definition[edit|edit source]

Synkinesis（AKA异常再生）发生伤害后发生facial nerveand it is a common sequelae of面部麻痹。The cause of the injury may beBell's Palsy,Ramsay Hunt Syndrome（不太常见），手术损伤（例如，在手术中移除acoustic neuroma），创伤（颅骨骨折）或其他引起面部瘫痪的病症。

synkinesis.= "syn" meaning "together" and "kinesis" meaning "movement". Therefore, synkinesis means "moving together" or "mass movement". Thus, synkinesis is when an involuntary movement accompanies a voluntary movement.[1]

The type of synkinesis is commonly described by combining the names of the two involved muscle groups, with the first part referring to the voluntary motor group and the second part referring to the involuntary muscle group. For instance:

  • Ocular-oral synkinesis is when voluntary eye contraction such as blinking or brow lifting elicits an involuntary mouth movement
  • 口腔眼综合征是当一个无意识的眼睛收缩伴随着一个激动的嘴巴运动，如微笑和嘴唇褶皱

Clinically Relevant Anatomy[edit|edit source]

The facial nerve is the seventh cranial nerve, and it controls the muscles of facial expression. More information on the anatomy of the facial nerve is availablehere。

损伤机制/病理过程[edit|edit source]

认为无意或大规模运动是由于在压缩或受损后发生的面神经的未分化再生引起的。[2]

人们认为“联带运动”可能是由four possible mechanisms:

  1. Aberrant regeneration[3][4][5]- “错过布线”
    • Axons regrow from the facial nucleus to incorrect peripheral muscle groups
    • It has generally been assumed that the site of the miss-wiring is the lesion site (i.e. where the nerve was damaged by crush / inflammation), but one 2004 study found that the regrowing axons are disorganised along their whole length, as well as at the lesion site[4]
  2. Ephaptic transmission[6]- 神经分支之间的电气串扰
    • 假定是由于神经纤维的减少的髓鞘，这意味着它们绝缘不佳
  3. Nuclear hyperexcitability[7][8]
    • This theory proposes that once the post-synaptic cell loses its input from the degenerated axons, it creates additional neurotransmitter receptors and, thus, becomes hypersensitive
    • Because of this hypersensitivity, it responds to neurotransmitters provided by another nerve nearby
  4. Maladaptive cortical plasticity[9]
    • A 2018 study using MRI found that there was cortical reorganisation in the primary sensorimotor area and the supplementary motor area in the brain

许多作者认为，这些机制的组合可能会涉及这些机制。

临床表现[edit|edit source]

虽然患者在Flaccid面部瘫痪后经历了脸部受影响的脸部的恢复和重新支配，但它们也体验了典型的Synkinesis的运动的非自愿链接。

The effects which are most commonly observed are:[10]

  1. When moving the mouth (e.g. smile, lip pucker, when eating), the eye on the affected side moves towards partial (or occasionally full) closure, whereas the unaffected eye remains wide open =oral-ocular
  2. When raising the eyebrows or closing the eyes, the corner of the mouth on the affected side of the face raises =ocular-oral

重要的是要认识到，Synkinesis经常从第五个或第六个月开始发生麻痹的第五个月，但在某些情况下，它可以早在第三个月发布发布，并且一般增加两年后发病。[11][12]

Scoring / Measuring Synkinesis[edit|edit source]

The most commonly used measure of facial range of movement by surgeons and physicians is theHouse-Brackmannscale.[13]Unfortunately, this scale does not have a rating for the aberrant linking of movements which occurs in synkinesis.

The SunnybrookFacial Grading System[FGS][14]is a more comprehensive scoring system for facial range of movement, and it has a section dedicated to rating the presence of synkinesis movements.[15]2015年对面神经分级系统的系统评价将FGS确定为满足最多标准的面部神经功能，后遗症和对治疗的反应。它也被识别为具有最高可靠性。[16]The FGS is sensitive enough to show gains when facial range of movement increases as well as if the person has a reduction in their synkinesis.

The Synkinesis Assessment Questionnaire consists of nine questions and has been shown to be both valid and reliable as a dedicated measurement of synkinesis.[17]还显示出与FGS的Synkinesis组件具有良好的相关性。

庄和同事还制定了一个novel classification system有四类：[18]

  • 模式I：良好的笑容（即良好的运动范围）和轻度妇女赛
  • Pattern II:Acceptable smile with moderate to severe synkinesis
  • 图案III：严重的Synkinesis的不可接受的微笑（很少或没有运动范围）
  • Pattern IV: Poor smile with mild synkinesis

这种评分Synkinesis的方法尚未在间间和内部的可靠性研究中进行评估，但它证明了一个有用的工具，以帮助庄楚决定管理层。[18]

Management / Interventions[edit|edit source]

Physiotherapy Interventions[edit|edit source]

The following physiotherapy interventions have been shown to be effective in reducing or minimising synkinesis:

Non-Physiotherapy Interventions[edit|edit source]

  • Botulinum toxin injections[23][24][25]
  • Surgery:
    • Used very infrequently - usually for severe synkinesis which has failed to respond to physiotherapy and botox
    • 使用的手术包括：选择性神经溶解，[26]selective myectomy,[27]selective neurectomy[28]和跨面神经移植[29]

差异诊断[edit|edit source]

synkinesis.is a clinical diagnosis. It is usually easy to diagnose as the patient will display clear linking of facial movements on the affected side only, and will have a history of facial palsy. Occasionally it can be confused with the following conditions:

  • Facial dystonia
  • 基本的睑板痉挛
  • Essential hemifacial spasm

资源[edit|edit source]

面部麻痹UKhas a comprehensive website, andthis pageexplains more about synkinesis.

References[edit|edit source]

References will automatically be added here, seeadding references tutorial。

  1. ↑陆妈妈ZZ, YC,Wu JJ, Li SS, Ding W, Xu JG.面部综合征中网络级空间模式的改变：一个独立的组件和连接分析。Ann Transl Med。2021;9(3):240.
  2. ↑拉斯兰A，Guntinas-Lichius O，Volk GF。改变了患有后术面部Synkinesis，喉镜的患者的面部肌肉支撑模式。2019; 130（5）：E320-E326。
  3. ↑Moran CJ，Neely JG。面部神经杂志的模式。喉镜。1996年; 106（12）：1491-6。
  4. ↑4.04.1Choi D，Raisman G.在面部神经损伤之后，再生轴突在神经的整个长度内变得异常，不仅在病变部位：实验研究。Br J Neurosurg。2004; 18（1）：45-8。
  5. ↑Yamada H, Hato N, Murakami S, Honda N, Wakisaka H, Takahashi H, Gyo K. Facial synkinesis after experimental compression of the facial nerve comparing intratemporal and extratemporal lesions. Laryngoscope. 2010;120(5):1022-7.
  6. ↑Sadjadpour K. After Postfacial palsy phenomena: faulty nerve regeneration or ephaptic transmission? Brain Res. 1975;95(2-3):403–6.
  7. ↑Sibony Pa，LeSsell S，Gitinger JW Jr.获取的动脉瘤织舞。Surv Ophthalmol。1984; 28（5）：382-90。
  8. ↑Husseman J, Mehta RP. Management of synkinesis. Facial Plast Surg. 2008;24:242-9
  9. ↑Wang Y, Wang WW, Hua XY, Liu HQ, Ding W. Patterns of cortical reorganization in facial synkinesis: a task functional magnetic resonance imaging study. Neural Regen Res. 2018;13(9):1637-42.
  10. ↑Beurskens CH, Oosterhof J, Nijhuis-van der Sanden MW. Frequency and location of synkineses in patients with peripheral facial nerve paresis. Otol Neurotol. 2010;31(4):671-5.
  11. ↑Fujiwara K，Furuta Y，Nakamaru Y，Fukuda S.面部综合征在外周面部神经麻痹前6和12个月的面部综合征比较。auris nasus learynx。2015; 42（4）：271-4。
  12. ↑POPMOMENY，AA和ASADI1，S.综合征和面部神经麻痹的不对称管理：审查文章。伊朗J Otorhinolaryngol。2014;26（77）：251-6。
  13. ↑House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985;93(2):146-7.
  14. ↑Ross BG, Fradet G, Nedzelski JM. Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg. 1996;114(3):380-6.
  15. ↑Neyzelski JM Neely JG，Cherian Ng，Dickerson CB。Sunnybrook面部分级系统：分级的可靠性和标准。喉镜。2010; 120（5）：1038-45。
  16. ↑Fattah Ay，Gurusinghe Adr，Gavilan J，Hadock Ta，Marcus JR，Marres H等人。面神经分级仪器：对文献的系统审查和均匀性建议。Plast Rescrst Surg。2015; 135（2）：569-79。
  17. ↑Mehta RP, WernickRobinson M, Hadlock TA. Validation of the Synkinesis Assessment Questionnaire. Laryngoscope. 2007;117(5):923-6.
  18. ↑18.018.1Chuang DC, Chang TN, Lu JC.Postparalysis facial synkinesis: clinical classification and surgical strategies。PLAST RESCRST SCOL GLOB OPEN。2015; 3（3）：E320。
  19. ↑Brach Js，Vanswearingen JM，Lenert J，Johnson PC。口腔综合征的面部神经肌肉刷新。Plast Rescrst Surg。1997年; 99（7）：1922-31。
  20. ↑Manikandan N. Effect of facial neuromuscular re-education on facial symmetry in patients with Bell's palsy: a randomized controlled trial. Clin Rehabil. 2007;21(4):338–43.
  21. ↑Ross B, Nedzelski JM, McLean JA. Efficacy of feedback training in long-standing facial nerve paresis. Laryngoscope. 1991;101(7):744–50.
  22. ↑Balliet R，Shinn JB，Bach-Y-Rita P.面部瘫痪康复：再培训选择性肌肉控制。int rehabil med。1982; 4（2）：67-74。
  23. ↑de Maio M, Bento RF. Botulinum toxin in facial palsy: an effective treatment for contralateral hyperkinesis. Plast Reconstr Surg. 2007;120(4):917-27.
  24. ↑Filipo R，Spahiu I，Covelli E，Nicastri M，Bertoli Ga。肉毒杆菌毒素治疗面部综合征和高核。喉镜。2012; 122（2）：266-70。
  25. ↑Markey JD, Loyo M, 2017. Latest advances in the management of facial synkinesis. Curr Opin Otolaryngol Head Neck Surg. 2017;25(4):265-72.
  26. ↑Bran GM, Lohuis PJ. Selective neurolysis in post-paralytic facial nerve syndrome (PFS). Aesthetic Plast Surg. 2014;38(4):742-4.
  27. ↑Guerrissi Jo。女性术治疗的选择性肌切除术。Plast Rescrst Surg。1991; 87（3）：459-66。
  28. ↑van Veen MM, Dusseldorp JR, Hadlock TA, 2018. Long-term outcome of selective neurectomy for refractory periocular synkinesis. Laryngoscope. 2018;128(10):2291-5.
  29. ↑Zhang B, Yang C, Wang W, Li W. Repair of ocular-oral synkinesis of postfacial paralysis using cross-facial nerve grafting. J Reconstr Microsurg. 2010;26:375-80

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