Botulinum Toxin Type A Timing Efficacy in Patients With Synkinesis After Bell's Palsy

Abstract

Objective: This study examines whether the timing of botulinum toxin type A (BoNTA) treatments affects outcomes in patients with synkinesis, a sequela of Bell's Palsy characterized by disconjugate facial muscle movement. Study Design: A retrospective chart review. Setting: An urban academic medical center. Methods: We reviewed the charts of synkinesis patients treated from 2016 to 2022. Data included procedural notes, intervention dates, and scores from the House–Brackmann (HB), Facial Clinimetric Evaluation (FaCE), Synkinesis Assessment Questionnaire (SAQ), and Facial Grading System (FGS). Results: Sixty-seven patients (median age 54 years, average palsy duration 5.7 years) received BoNTA. Patients treated within 12 months (n = 28), 13 to 24 months (n = 12), and after 24 months (n = 23) showed no significant differences in changes to HB, FaCE, or SAQ scores. However, patients treated within 1 year had significantly higher FGS improvement (36.3) than the other groups (P =.03). Conclusion: While FaCE, HB, and SAQ scores showed no significant differences, early BoNTA treatment within 1 year significantly improved FGS scores, indicating better outcomes. Therefore, early treatment is ideal for optimal response.