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Scientific Oral Presentations

Facial Plastic and Reconstructive Surgery

Session: Scientific Oral Presentation 3 - Facial Plastics and Reconstructive Surgery

Does Electrical Stimulation Therapy Influence Synkinesis in Facial Paralysis? A Systematic Review

Tuesday, October 14, 2025
11:18 AM - 11:24 AM EDT
Location: 137
Disclosure(s):
Hanel W. Eberly, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jeffrey Lorenz, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Heather K. Schopper, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Facial nerve paralysis (FP) has aesthetic, social, and functional consequences. Electrical stimulation (ES) has shown promising results in treating peripheral nerve injury. However, its use in FP is controversial as it may confer an increased risk of synkinesis.

Methods: A review was conducted using the Medline/PubMed, Cochrane, and Web of Science databases. Included articles assessed the incidence or severity of synkinesis following ES in patients with FP. Foreign language articles and articles on electrodiagnostic technology or hemifacial spasm were excluded. Data extracted included patient demographics, ES parameters, etiology of FP, severity or presence of synkinesis, and treatment duration. Methods for meta-analysis were performed including a fixed-effects model and tests of homogeneity.

Results: Database searches yielded 543 papers and 6 articles were included. There were a total of 243 patients, of which 92 were female (n=5/6 papers). The most common etiology of FP was Bell’s palsy (76.5%), followed by iatrogenic facial nerve injury (20.2%). Time to treatment from onset of FP ranged from within one week of onset to after five months of conventional treatment. Treatment duration ranged from 2 weeks to 29 months, with a range of 30-3000ms inter-impulse gap, 10-700ms phase duration, and 0.5-27mA. All ES was delivered transcutaneously. Sunnybrook, Facial Grading Scale, and eFACE synkinesis scores were used to assess symptom improvement (n=4 papers), with two papers evaluating patients using the House-Brackmann scale. The difference in mean Sunnybrook scores (n=4 papers) was 4.46 (1.43,7.49, p=0.004) for the fixed-effects model, with higher scores observed in the group receiving ES. This model was used due to the low observed heterogeneity (I2=0%, Chi2=2.58). There were no differences in the Sunnybrook synkinesis score between groups.

Conclusions: In this study, overall Sunnybrook scores were higher in patients following ES and no differences were observed for the synkinesis score only. Inconsistencies in synkinesis outcomes and measurement underscore the need for further research in this area.

    Presenting Author(s)

  • Hanel W. Eberly, MD

    Resident
    Yale New Haven Hospital
    Fairfield, Connecticut, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • MA

    Marly Aziz, BS

    Penn State College of Medicine, United States

    Disclosure information not submitted.

  • Jeffrey Lorenz, MD

    Resident
    Penn State College of Medicine, Department of Otolaryngology – Head and Neck Surgery
    Hershey, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • HS

    Heather K. Schopper, MD

    Assistant Professor - Facial Plastic and Reconstructive Surgery
    Penn State College of Medicine, Department of Otolaryngology – Head and Neck Surgery
    Hershey, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Senior Author(s)

  • Jessyka G. Lighthall, MD

    Chief, Division of Facial Plastic & Reconstructive Surgery
    Professor, Penn State College of Medicine, Department of Otolaryngology – Head and Neck Surgery
    Hershey, PA, United States

    Disclosure information not submitted.