{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T19:46:08Z","timestamp":1785267968636,"version":"3.55.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T00:00:00Z","timestamp":1525132800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["JAMA Facial Plast Surg"],"published-print":{"date-parts":[[2018,5]]},"abstract":"\n Importance<\/jats:title>\n The buccinator, despite being a prominent midface muscle, has been previously overlooked as a target in the treatment of facial synkinesis with botulinum toxin.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate outcomes of patients treated with botulinum toxin to the buccinator muscle in the setting of facial synkinesis.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Prospective cohort study of patients who underwent treatment for facial synkinesis with botulinum toxin over multiple treatment cycles during a 1-year period was carried out in a tertiary referral center.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Botulinum toxin treatment of facial musculature, including treatment cycles with and without buccinator injections.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Subjective outcomes were evaluated using the Synkinesis Assessment Questionnaire (SAQ) prior to injection of botulinum toxin and 2 weeks after treatment. Outcomes of SAQ preinjection and postinjection scores were compared in patients who had at least 1 treatment cycle with and without buccinator injections. Subanalysis was performed on SAQ questions specific to buccinator function (facial tightness and lip movement).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 84 patients who received botulinum toxin injections for facial synkinesis, 33 received injections into the buccinator muscle. Of the 33, 23 met inclusion criteria (19 [82.6%] women; mean [SD] age, 46 [10] years). These patients presented for 82 treatment visits, of which 44 (53.6%) involved buccinator injections and 38 (46.4%) were without buccinator injections. The most common etiology of facial paralysis included vestibular schwannoma (10 [43.5%] participants) and Bell Palsy (9 [39.1%] participants). All patients had improved posttreatment SAQ scores compared with prebotulinum scores regardless of buccinator treatment. Compared with treatment cycles in which the buccinator was not addressed, buccinator injections resulted in lower total postinjection SAQ scores (45.9; 95% CI, 38.8\u201346.8; vs 42.8; 95% CI, 41.3\u201350.4;\n P<\/jats:italic>\n \u2009=\u2009.43) and greater differences in prebotox and postbotox injection outcomes (18; 95% CI, 16.2\u201321.8; vs 19; 95% CI, 14.2\u201321.8;\n P<\/jats:italic>\n \u2009=\u2009.73). Subanalysis of buccinator-specific scores revealed significantly improved postbotox injection scores with the addition of buccinator injections (5.7; 95% CI, 5.0\u20136.4; vs 4.1; 95% CI, 3.7\u20134.6;\n P<\/jats:italic>\n \u2009=\u2009.004) and this corresponded to greater differences between prebotulinum and postbotulinum injection scores (3.3; 95% CI, 2.7\u20133.9; vs 2.0; 95% CI, 1.4\u20132.6;\n P<\/jats:italic>\n \u2009=\u2009.02). The duration of botulinum toxin effect was similar both with and without buccinator treatment (66.8; 95% CI, 61.7\u201369.6; vs 65.7; 95% CI, 62.5\u201371.1;\n P<\/jats:italic>\n \u2009=\u2009.72).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The buccinator is a symptomatic muscle in the facial synkinesis population. Treatment with botulinum toxin is safe, effective and significantly improves patient symptoms.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n \n 3<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamafacial.2017.1385","type":"journal-article","created":{"date-parts":[[2017,10,3]],"date-time":"2017-10-03T15:34:45Z","timestamp":1507044885000},"page":"196-201","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":35,"title":["Outcomes of Buccinator Treatment With Botulinum Toxin in Facial Synkinesis"],"prefix":"10.1177","volume":"20","author":[{"given":"Priyesh N.","family":"Patel","sequence":"first","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott R.","family":"Owen","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathey P.","family":"Norton","sequence":"additional","affiliation":[{"name":"Pi Beta Phi Rehabilitation Institute, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon T.","family":"Emerson","sequence":"additional","affiliation":[{"name":"University of Tennessee Medical School, Memphis, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea B.","family":"Bronaugh","sequence":"additional","affiliation":[{"name":"Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R.","family":"Ries","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott J.","family":"Stephan","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,5,17]]},"reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2013.04.012"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/eye.2011.158"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22404"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fsc.2015.09.008"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2008-1075840"},{"issue":"3","key":"e_1_3_1_7_2","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1097\/IOP.0000000000000086","article-title":"Subjective and objective outcome measures in the treatment of facial nerve synkinesis with onabotulinumtoxinA (Botox)","volume":"30","author":"Couch SM","year":"2014","unstructured":"Couch SM, , Chundury RV, , Holds JB. Subjective and objective outcome measures in the treatment of facial nerve synkinesis with onabotulinumtoxinA (Botox). Ophthal Plast Reconstr Surg. 2014; 30(3):246-250.","journal-title":"Ophthal Plast Reconstr Surg"},{"issue":"4","key":"e_1_3_1_8_2","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1080\/01676830490512233","article-title":"Treatment of aberrant facial nerve regeneration with botulinum toxin A","volume":"23","author":"Chua CN","year":"2004","unstructured":"Chua CN, , Quhill F, , Jones E, , Voon LW, , Ahad M, , Rowson N. Treatment of aberrant facial nerve regeneration with botulinum toxin A. 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Eur Arch Otorhinolaryngol. 1994; S195-S199.","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"1","key":"e_1_3_1_13_2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1097\/01.sap.0000250761.26824.4f","article-title":"Automated facial image analysis: detecting improvement in abnormal facial movement after treatment with botulinum toxin A","volume":"58","author":"Rogers CR","year":"2007","unstructured":"Rogers CR, , Schmidt KL, , VanSwearingen JM, et al. Automated facial image analysis: detecting improvement in abnormal facial movement after treatment with botulinum toxin A. 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Ophthal Plast Reconstr Surg. 2016; 32(2):138-141.","journal-title":"Ophthal Plast Reconstr Surg"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLG.0b013e3180412460"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2273.1996.tb01018.x"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24732"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269215507073177"},{"issue":"1","key":"e_1_3_1_20_2","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/IOP.0000000000000608","article-title":"Re: \u201cTreating buccinator with botulinum toxin in patients with facial synkinesis: a previously overlooked target.\u201d","volume":"32","author":"Chundury RV","year":"2016","unstructured":"Chundury RV, , Perry JD. Re: \u201cTreating buccinator with botulinum toxin in patients with facial synkinesis: a previously overlooked target.\u201d. 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