Management of Synkinesis and Hyperkinesis

Injection of botulinum toxin can be quite helpful for patients who develop hyperkinesis following reinnervation (e.g., after XII to VII cross-innervation). It may also be helpful for patients who have severe synkinesis that results in excessive facial twitches. The toxin is injected into the orbicularis oculi muscle for eyelid spasms and into the zygomaticus major muscle for midfacial spasms. EMG may be helpful in localizing the muscle for injection. An initial dose of 5 to 10 U can be injected into the orbicularis oculi and 10 to 20 U into the zygomaticus and then repeated if necessary to achieve the desired results. The duration of effect lasts approximately 3 months, and patients will require repeated injection.

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