Signs of synkinesis

Synkinesis is the development of linked or unwanted facial movements during voluntary facial expression.  It occurs in the majority of people who experience a slow recovery from their facial palsy. Approximately 30% of people diagnosed with Bell’s palsy will experience some form of synkinesis.

Your regular stage assessments are designed to pick up on synkinetic symptoms as they start to develop. If you report signs of synkinesis we will update your recovery plan and recommend the best therapy for your stage.

Common abnormal movement patterns that can appear

  • Involuntary eye closure whilst smiling, whistling, pressing the lips together, eating and/or drinking.
  • Involuntary brow raising during eye closure, smile, and/or whistle.
  • Involuntary cheek lifting during eye closure, blinking, brow raise, whistle, and/or speaking.
  • Involuntary chin movements during all types of facial expression but commonly during smile, whistle and tight eye closure.
  • Involuntary neck movements during all types of facial expression but commonly during smile, whistle and tight eye closure.

Watching for the signs  

  • It normally appears at approximately 12 – 16 weeks (or later), after the onset of your facial palsy.
  • Prior to the onset of synkinesis, it is likely that the facial muscles on the affected side of your face have become thicker, perhaps tender to touch, and also shorter.
  • You may notice that the affected corner of your mouth has started to lift because the cheek muscles have shortened.
  • You may notice that the affected eye has become narrow compared to the unaffected eye because the ring of eye muscles have become tighter and shorter.
  • Synkinesis can appear quite suddenly although your nerve has probably been overactive for several weeks or months causing the muscles to tighten and thicken.

What you should do when you first notice synkinesis?

  • Take your stage assessment so we can update your Recovery Plan and Practice video library.
  • Practice regular facial relaxation.  If you have lost your way with these, then go back and start again.
  • Only practice gentle movements.
  • Avoid effortful movements at all costs as this will increase the severity of synkinesis.
  • Do not force facial expressions.
  • Remember all movement practice should be slow, gentle, and symmetrical.

Read more

The stages of facial palsy

Week 4-6

Week 6-12

Week 12-16