management of facial synkinesis with a combination of btx-a and biofeedback: a randomized trial

introduction: synkinesis and facial asymmetry due to facial nerve palsy are distressing conditions that affect quality of life. unfortunately, these sequelae of facial nerve palsy are unresolved. the aim of this study was to investigate the efficacy of a combination of biofeedback therapy and botulinum toxin a (btx-a) injection for the management of synkinesis and asymmetry of facial muscles.   materials and methods: among referrals from three university hospitals, 34 patients with facial synkinesis were divided randomly into two groups. all participants wereevaluated using photoshop software, videotape, and facial grading system (fgs). the firstgroup received a single dose of btx-a at the start of treatment, while the second group received normal saline as a control. bothgroups received electromyography (emg) biofeedback threetimes a week for 4 months.   results: the mean fgs values for the btx group before and after treatment were 55.17and 74.17, respectively, and those for the biofeedback group were 66.31 and 81.37,respectively. moreover, it was shown that in both groups oral-ocular and oculo-oral synkinesisdecreased significantly after treatment compared with before treatment (p0.05).   conclusion: biofeedback therapy is as effective as the combination of biofeedback and btx in reducing synkinesis and recovery of facialsymmetry in bell's palsy.