So, a few days ago, my webmaster asked me – “Hey, what about those blogs you promised me.” This was not the first time he asked this question. Between patients, research, mentoring at work, and life outside of work, I neglected my blogs. I intended to share my blogs with my patients on different aspects of my clinical work, including some occasional thoughts, which I hope will be informative beyond the scope of the site. I will try to do this on a more regular basis.
Is all synkinesis the same?
A few months ago, a patient with synkinesis asked me whether I had seen a patient exactly like her before. My answer was, yes and no. In truth, no patient is exactly alike, and each is unique. The other truth is, that as humans we have similarities, and this includes similarities in which we present with medical problems. In other words, similar patterns with a certain degree of variability.
She specifically had fairly mild synkinesis, and I told her that although she has some facial asymmetry, the asymmetry is within the normal range of asymmetries in us humans, but the choice was hers on how she would want to proceed. She pondered for a moment and said “I understand what you are saying, but this is not me. Could you go into more details on the synkinesis treatment options we have, and I can then make a decision?”.
The Decision-Making Process
This was only a small part of the conversation but a very important one. We, as humans, understand that we are all different and that normal is relative. But when we had something, and now we have less of it, especially when it relates to our appearance and function, we want it back. Decision-making takes time and is also varies among different individuals. Sometimes we have more time to decide, and sometimes we are racing against time.
When we can choose a time, then perhaps the most important thing is to be comfortable as much as you can with your decision. For that, you need to feel comfortable with your surgeon and ask questions. Take your time. Feel free to ask the same question several times until you understand. Certainly, as physicians and surgeons we are not perfect, but a good surgeon will always aspire to get you the best results possible.
Synkinesis has a very wide range of presentation, ranging from very mild muscle spasms and uncoordinated facial motion to more severe presentations, which include a constant strong contracture of the facial muscles associated with very limited motion. In some patients a smaller surgery can help, while in others a slightly more involved surgery is required. In certain instances, we will take a gradual, stepwise approach, necessitating several procedures in order to optimize results. Some of the synkinesis treatments available include:
Also, it is important to remember that in nearly all instances of synkinesis, the optimal strategy most frequently involves a combination of physical therapy, use of BOTOX, and surgery. It’s important to discuss your particular case since this prepares you better for the journey. Each journey is different, but I personally believe that taking this journey together makes it easier for both patient and surgeon, improves outcomes, and provides a great opportunity to learn from each other.
And yes, as for our patient, she decided to proceed. She already has better function and is starting to feel better about herself.
If you’ve been diagnosed with synkinesis and would like to discuss your treatment options with Dr. Rozen, request a consultation with him at UT Southwestern Medical Center in Dallas. You can see some of Dr. Rozen’s patients’ synkinesis treatment results in our photo gallery.