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Scientific Oral Presentation

Facial Plastic and Reconstructive Surgery

Characterizing Facial Synkinesis After Facial Neural Reanimation Surgery

Monday, October 19, 2026
1:36 PM - 1:42 PM PT
Location: 404A
Introduction: Facial neural reanimation surgery, including hypoglossal-facial nerve transfer, masseteric-facial nerve transfer, and dual nerve transfer, are successful treatment options for flaccid facial paralysis and are also associated with post-reanimation facial synkinesis. This study aims to characterize the onset, presentation, and predictors of facial synkinesis in patients after facial neural reanimation surgery.

Methods: A retrospective, single-institution study was conducted of patients with flaccid facial paralysis who underwent hypoglossal-facial, masseteric-facial, or dual nerve transfer from 2017 - 2025. Demographic, clinical, and operative variables were collected. Outcomes included development of facial synkinesis, time to onset, post-operative Sunnybrook Facial Grading Scale scores, and chemodenervation treatment.

Results: 29 patients were identified (51.7% male, 86.2% white). Preoperative House-Brackmann scores ranged from III to VI. Mean age at onset of facial palsy was 47.2 years, with cerebellopontine angle or intracranial tumor being the most common etiology (44.8%). Treatment of paralysis with dual nerve transfer (58.6%) was most common, followed by masseteric-facial nerve transfer (41.4%). Postoperatively, 31.0% of patients developed synkinesis, with a mean time of onset of 12.1 months (SD: 5.6 months). Patients with preoperative synkinesis were significantly more likely to develop postoperative synkinesis (p=0.003). The presentation of facial synkinesis was heterogeneous, with affected facial regions ranging from forehead to neck. Five (56%) patients received chemodenervation treatment for facial synkinesis.

Conclusions: In this single-institution retrospective study, nearly one-third of patients developed facial synkinesis following facial nerve reanimation with wide variability in timing and clinical presentation. Patient clinical factors are associated with postoperative facial synkinesis development. These findings can inform patient counseling and postoperative clinical management.