Synkinesis vs Hemifacial Spasm: What’s the Difference

Synkinesis and hemifacial spasm are two distinct conditions that are often confused with each other because they both cause involuntary movements in the facial region, but they actually have completely different mechanisms. These conditions also raise questions such as, “Are the twitches I'm experiencing due to paralysis, or is there another disease?” Therefore, to address your concerns and provide answers to your questions, we have created the content titled “Synkinesis vs Hemifacial Spasm: What's the Difference?” You can find detailed information by reviewing the content. We wish you all good health and happy reading.

Why Are Synkinesis and Hemifacial Spasm Confused?

Synkinesis and hemifacial spasm are two distinct facial movement disorders that are often confused because they present similar symptoms in most patients. Both disorders can involve involuntary contractions, uncontrolled facial movements, and noticeable changes on one side of the face. However, what appears to be “facial twitching” from the outside is actually the result of two completely different mechanisms. This is because synkinesis usually occurs during the recovery phase after facial paralysis due to misfiring nerve connections; that is, when attempting one movement, another muscle involuntarily engages. Hemifacial spasm, on the other hand, is a neurological condition characterized by sharp, rhythmic, and repetitive contractions caused by nerve compression or irritation from a blood vessel. Since patients present with complaints of “uncontrollable facial movements” in both conditions, accurate differentiation can only be made through detailed neurological evaluation, examination, and tests such as EMG if necessary. Therefore, confusion between the two conditions is quite common; however, since the treatment approaches are completely different, accurate diagnosis is of great importance.

In Which Disease Are Facial Paralysis Symptoms Directly Observed?

Neither synkinesis nor hemifacial spasm are diseases that begin directly with facial paralysis. Therefore, neither of them is a condition in which facial paralysis symptoms are directly observed. Within this scope, synkinesis is a secondary condition that arises when nerve healing occurs in the wrong direction in a patient who has had facial paralysis. In other words, facial paralysis must be present at the outset, but synkinesis is not the cause of facial paralysis, but rather its consequence. Hemifacial spasm, on the other hand, is a neurological condition characterized by sudden and recurrent spasms caused by compression of the facial nerve by a blood vessel. In this disease, there is no muscle weakness or paralysis in the facial muscles; on the contrary, the muscles work excessively and uncontrollably. Therefore, it would be incorrect to say that both conditions directly present with facial paralysis symptoms. In short, synkinesis is the result of improper healing after paralysis, while hemifacial spasm is the result of a completely different mechanism and is not related to paralysis.

Which Is More Common in People Who Have Had Facial Paralysis?

The most common secondary condition in people who have had facial paralysis is synkinesis. This is because synkinesis occurs as a result of some nerve fibers branching incorrectly and forming faulty connections to different muscle groups during the healing process of the facial nerve. Therefore, many patients who initially experience paralysis begin to exhibit accompanying movements over time, such as the corner of the mouth being pulled when closing the eye, the eye involuntarily contracting when smiling, or stiffness and contraction in a part of the face. Since hemifacial spasm develops due to vascular-nerve contact, it is much less likely to occur in people with a history of paralysis than synkinesis. Therefore, the most common problem encountered by patients in the post-facial paralysis period is synkinesis, which develops due to incorrect healing and can be controlled with regular follow-up and appropriate rehabilitation.

Precautions to Avoid Synkinesis Disorder

There are certain key points to consider in order to avoid synkinesis disorder. By paying attention to these points, you can reduce your risk of developing synkinesis. In this context, the precautions to avoid synkinesis disorder are as follows:

• Do not neglect specialist supervision during the initial phase of facial paralysis: Early follow-up by a neurologist or a physician specializing in facial nerves is critical in reducing the risk of incorrect healing.
• Avoid excessive facial exercises: Unconscious, frequent, or excessive forceful exercises may increase the likelihood of incorrect nerve fiber connections. Therefore, perform your exercises under the supervision of a specialist.
• Receive proper physical therapy under the guidance of a specialist: Customized facial rehabilitation helps retrain muscles correctly and prevents incorrect movement patterns. Therefore, be sure not to neglect physical therapy.
• Avoid strenuous facial movements: Insisting on making facial expressions, stretching facial muscles with a feeling of “strain,” or exercising them vigorously is risky in terms of incorrect healing. For this reason, be careful not to make strenuous facial movements.
• Do not undergo electrical stimulation in the early stages: Electrical muscle stimulation is not recommended as it can lead to abnormal nerve branching. Therefore, avoid electrical stimulation treatment without expert advice.
• Managing fatigue and stress: Stress can increase tension in the facial muscles and trigger involuntary contractions during the healing process.
• Performing massage and heat therapy at the right time and with the right technique: Improper massage techniques can increase muscle tone and raise the risk of synkinesis. Therefore, perform/receive massage using the correct techniques.
• Using eye and mouth movements naturally in daily life: Natural and controlled facial expressions, without straining, help guide nerve healing in the right direction.
• Avoiding excessive facial expressions: Avoid excessive facial expressions, especially in the early stages of healing, as intense facial movements can disrupt muscle balance.

Precautions to Avoid Hemifacial Spasm

There are certain precautions you should take to avoid hemifacial spasm. By paying attention to these points, you can reduce your risk of developing the condition. In this context, here are some precautions you should take to protect yourself from hemifacial spasm:

• Pay attention to stress management: Stress can increase sensitivity in nerve structures and trigger involuntary contractions in the facial muscles.
• Maintain a regular sleep schedule: Insufficient sleep can negatively affect nerve transmission, making muscle twitching more pronounced. Therefore, pay attention to your sleep schedule.
• Reducing eye strain: Since spending long periods in front of a screen can cause the muscles around your eyes to overwork and become irritated, take steps to reduce eye strain.
• Avoiding unnecessary strain on facial muscles: Teeth clenching, hard chewing, or habits that keep your facial muscles constantly active can increase nerve tension. Therefore, avoid straining your facial muscles unnecessarily.
• Limit sudden cold contact with the neck and face area: Cold can increase muscle tone and trigger twitching attacks.
• Eat a balanced diet rich in magnesium and B vitamins: Be sure to consume magnesium and B vitamins, as they support nerve health and reduce the risk of spasms.
• Keep your blood pressure under control: Since high blood pressure is known to be a risk factor that can increase vascular-nerve contact, keep your blood pressure under control.
• See a doctor immediately if you experience throbbing pain or sudden spasms in your face: If you experience throbbing pain or sudden spasms in your face, see a specialist immediately.

The Difference Between Synkinesis and Hemifacial Spasm

Although synkinesis and hemifacial spasm are known as similar disorders, there are differences between them. Within this scope, the differences between synkinesis and hemifacial spasm are as follows:

• The reason for its emergence is different

Synkinesis occurs in people who have had facial paralysis when some nerve fibers connect to the wrong muscle groups during nerve healing. In essence, it is a problem of “incorrect healing” and is a natural but undesirable result of nerve damage. Hemifacial spasm, on the other hand, usually occurs due to constant stimulation of the facial nerve caused by pressure from a blood vessel. The nerve is compressed by the blood vessel, and this irritation leads to involuntary contractions. Therefore, hemifacial spasm is a neurological disorder centered on nerve compression.

• The initial process is different

Synkinesis is not seen in the early stages of facial paralysis. It appears weeks or months after facial paralysis as the nerve begins to heal and gradually becomes more pronounced. Hemifacial spasm, on the other hand, is completely independent of facial paralysis and usually begins suddenly. In this context, the first symptom may be an increase in unilateral blinking or slight twitching, which becomes more frequent over time. In other words, the patient does not need to have a history of facial paralysis.

• The type of movement is different

In synkinesis, movements are triggering; when the patient attempts to make a facial expression, another muscle group involuntarily joins in. For example, when blinking, the corner of the mouth may twitch. In hemifacial spasm, however, movements occur spontaneously; even if the person makes no movement, sudden rhythmic twitching may occur around the eyes or face. Furthermore, the contractions are completely beyond the person's control and independent of their actions.

• The behavior of facial muscles is different

In synkinesis, the facial muscles work simultaneously in an uncoordinated manner. This manifests as tension, stiffness, simultaneous contraction, and involuntary movement of the facial muscles. On the other hand, in hemifacial spasm, the muscles undergo sudden, sharp, and repetitive contractions. These contractions can sometimes last for seconds, and strong tremors resembling tremors can be seen in the facial muscles.

• The symptom area may vary

Synkinesis most commonly manifests in the eye and mouth area. For example, “accompanying movements” such as closing the eyes and pulling the mouth, or squinting the eyes when smiling, are typical. Hemifacial spasm usually starts around the eyes and can spread to the cheek, mouth, jaw, and neck over time. In addition, twitching tends to start at one point and spread to a large area on one side of the face.

• The relationship with facial paralysis is different

Synkinesis occurs in people who have had facial paralysis; synkinesis does not develop without facial paralysis. This is because it is a result of the paralysis healing incorrectly. However, hemifacial spasm is not related to facial paralysis. Hemifacial spasm can occur even if the person has never had facial paralysis before. This is because the underlying cause is neurological stimulation due to vascular-nerve contact.

• Their treatments are different

Facial rehabilitation, specialized facial expression training, biofeedback, exercises that re-teach nerve-muscle coordination, and targeted botulinum toxin applications are used in the treatment of synkinesis. The goal is to reprogram the muscles correctly. On the other hand, botulinum toxin is the most effective and common solution for hemifacial spasm treatment. If a blood vessel pressing on the nerve is identified, the pressure can be relieved with a surgery called microvascular decompression (MVD). In other words, the treatment aims to reduce the pressure on the nerve by targeting the mechanism.