Advertisement

Aesthetic Plastic Surgery

, Volume 43, Issue 1, pp 98–101 | Cite as

Synkinesis Between Orbicularis Oculi and Procerus Muscles: Video Presentation of an Unusual Type of Aberrant Innervation after Cosmetic Rhinoplasty

  • Bahram Eshraghi
  • Hadi GhadimiEmail author
  • Mojgan Nikdel
  • Fazl Hajizadeh
Original Article Facial Surgery
  • 86 Downloads

Abstract

Background

Synkinesis is a recognized complication following peripheral facial nerve paralysis. Different types of synkinesis have been described, with oral–ocular and ocular–oral synkinesis being the most common. Ocular–nasal synkinesis has been reported in two patients following cosmetic rhinoplasty. However, synkinesis between the orbicularis oculi and procerus muscles has not been reported by now.

Methods

This is an interventional case report.

Results

Two women, aged 42 and 37 years, presented with unilateral contraction of the medial eyebrow muscles (procerus) with spontaneous or voluntary blinking, 4 and 5 months after cosmetic rhinoplasty, respectively. Both were successfully treated with injection of botulinum toxin A.

Conclusions

Surgical trauma is inevitable during every procedure, including rhinoplasty, and may damage the fine structures including branches of the facial nerve innervating the muscles. Gentle tissue handling may minimize iatrogenic injury to the fine motor branches of the facial nerve and prevent subsequent aberrant innervation and synkinesis. Botulinum toxin A injection can effectively, yet temporarily, resolve the unintentional contractions and provide significant patient comfort.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.

Keywords

Esthetics Botulinum toxin type A Facial nerve Rhinoplasty Synkinesis 

Notes

Acknowledgments

The authors appreciate the expert advice by Professor Keyvan Aghazadeh on this paper.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

Supplementary material 1 (MP4 2265 kb)

Supplementary material 2 (MP4 2744 kb)

Supplementary material 3 (MP4 5227 kb)

References

  1. 1.
    Crumley RL (1979) Mechanisms of synkinesis. Laryngoscope 89:1847–1854Google Scholar
  2. 2.
    Choi D, Raisman G (2002) Somatotopic organization of the facial nucleus is disrupted after lesioning and regeneration of the facial nerve: the histological representation of synkinesis. Neurosurgery 50:355–362Google Scholar
  3. 3.
    Kalantar Motamedi MH, Ebrahimi A, Shams A, Nejadsarvari N (2016) Health and social problems of rhinoplasty in Iran. World J Plast Surg 5:75–76Google Scholar
  4. 4.
    Kayabaşoğlu G, Dizdar D (2017) An effective technique for nasal radix reduction in septorhinoplasty: procerus muscle resection. J Craniofac Surg 28:2143–2144CrossRefGoogle Scholar
  5. 5.
    Batioglu-Karaaltin A, Karaaltin MV, Uzun N, Adatepe T, Ozdemir G, Ertas B (2015) Effects of open technique rhinoplasty on mimicry: electroneurographic evaluation. J Craniofac Surg 26:1348–1351CrossRefGoogle Scholar
  6. 6.
    Ross AH, Elston JS, Marion MH, Malhotra R (2011) Review and update of involuntary facial movement disorders presenting in the ophthalmological setting. Surv Ophthalmol 56:54–67CrossRefGoogle Scholar
  7. 7.
    Moran CJ, Neely JG (1996) Patterns of facial nerve synkinesis. Laryngoscope 106:1491–1496CrossRefGoogle Scholar
  8. 8.
    Husseman J, Mehta RP (2008) Management of synkinesis. Facial Plast Surg 24:242–249CrossRefGoogle Scholar
  9. 9.
    Rahman I, Sadiq SA (2007) Ophthalmic management of facial nerve palsy: a review. Surv Ophthalmol 52:121–144CrossRefGoogle Scholar
  10. 10.
    Markey J, Loyo M (2017) Latest advances in the management of facial synkinesis. Curr Opin Otolaryngol Head Neck Surg 25:265–272CrossRefGoogle Scholar
  11. 11.
    Maria CM, Kim J (2017) Individualized management of facial synkinesis based on facial function. Acta Otolaryngol 137:1010–1015CrossRefGoogle Scholar
  12. 12.
    Dutton JJ (2011) Atlas of clinical and surgical orbital anatomy, 2nd edn. Elsevier Saunders, PhiladelphiaGoogle Scholar
  13. 13.
    Caminer DM, Newman MI, Boyd JB (2006) Angular nerve: new insights on innervation of the corrugator supercilii and procerus muscles. J Plast Reconstr Aesthet Surg 59:366–372CrossRefGoogle Scholar
  14. 14.
    Guarro G, Brunelli F, Rasile B, Alfano C (2017) Oculonasal synkinesis: video report and surgical solution of a rare phenomenon. Aesthet Surg J 37:879–883CrossRefGoogle Scholar
  15. 15.
    Kosins AM, Palhazi P (2017) Commentary on: oculonasal synkinesis: video report and surgical solution of a rare phenomenon. Aesthet Surg J 37:884–886CrossRefGoogle Scholar
  16. 16.
    Guyuron B, Bokhari F, Galloway DV, Thomas T (1994) Oculonasal synkinesis. Plast Reconstr Surg 94:251–253CrossRefGoogle Scholar
  17. 17.
    Cakir B (2016) Aesthetic Septorhinoplasty. Springer, New YorkCrossRefGoogle Scholar
  18. 18.
    Axelsson S (2013) Bell’s Palsy—medical treatment and influence of prognostic factors. Faculty of Medicine Doctoral Dissertation Series 2013, Lund University, p 49Google Scholar
  19. 19.
    May M, Schaitkin BM (2000) The facial nerve. Thieme, New YorkGoogle Scholar
  20. 20.
    Borodic G, Bartley M, Slattery W, Glasscock M, Johnson E, Malazio C, Goodnough M, Acquadro M, McKenna M (2005) Botulinum toxin for aberrant facial nerve regeneration: double-blind, placebo-controlled trial using subjective endpoints. Plast Reconstr Surg 116:36–43CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  1. 1.Eye Research Center, Farabi Eye HospitalTehran University of Medical SciencesTehranIran

Personalised recommendations