Objective: To clarify unusal facial synkinesia by using surface electromyogram and botulinum toxin A.

Background: Marin-Amat syndrome is a facial synkinesis manifesting as involuntary eyelid closure on jaw opening. We describe three cases both involuntary eyelid closure on lower facial muscle movements and involuntary lower facial muscle movements on eyelid closure coexist. These movements are proven by their chief complaints and by surface electromyogram.

Methods: We report three cases.

Results: cAll three cases have past medical history of ipsilateral Bell’s palsy. 33-year-old male,71-year-old female,61-year-old female are included. Their chief complaints were involuntary eyelid closure and involuntary lower facial muscle movements. All three cases were successfully treated by botulinum toxin A every 3 or 4 month. The total dose in their every injection is 5.75 U, 7 U, 7 U respectively. By using surface electromyogram we could easily describe their eyelid closure induced involuntary lower facial muscle movements, and their lower facial muscle movements induced involuntary eyelid closure; interactive Marin-Amat syndrome.

Conclusions: Unusual facial synkinetic movements after Bell’s palsy are similar to hemifacial spasm, and treated almost the half dose of botulinum toxin A. Not only involuntary eyelid closure but also involuntary lower facial muscle movements exist in these facial synkinetic movements.

References: 1.N Engl J Med. 2016 Jun 2;374(22):e27.

2.Mov Disord. 1994 Jul;9(4):451-4.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unusual-facial-synkinesia-after-bells-palsy-interactive-marin-amat-syndrome-proven-by-surface-electromyogram-successfully-treated-with-low-dose-botulinum-toxin-a/