{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:25:42Z","timestamp":1793330742524,"version":"4.5.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"abstract":"\n Importance<\/jats:title>\n Facial synkinesis manifestations are well established, but no trait-based phenotypic stratification exists with implications for static and dynamic treatment planning.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To present clinically observable clusters of resting features in patients with stabilized facial synkinesis with implications for guiding potential static and dynamic treatment considerations.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This single-center retrospective cross-sectional study used videographic and photographic data from January 2009 to March 2025 from a tertiary academic referral center. Inclusion criteria required standardized images and videos captured at least 16 months after facial paralysis onset, prior to synkinesis operations, and at least 3 months following chemodenervation. Patients without all standardized photos and videos or bilateral synkinesis were excluded. Determinations were made by 3 independent evaluators.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n This clustering study of resting phenotypes did not involve any patient exposures.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was classification of patients into clinically observable phenotypic clusters. Secondary outcomes included comparisons of etiological and medical characteristics between the identified phenotypes, with clinician-graded eFACE facial nerve scale scores quantifying facial synkinesis severity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 549 consecutive patients with facial synkinesis evaluated, 160 were included in the study. Overall, 128 patients (80%) were female, and the mean (SD) age at paralysis onset was 41 (16) years. Median (IQR) follow-up time was 1.1 (0.2-3.1) years. Mean (SD) eFACE synkinesis score was 53 (16); median time from paralysis onset to evaluation was 5.4 (range, 1.4-36.0) years. Three phenotypes were identified. Type 1, identified in 93 patients (58%), represented notable resting hypertonicity and facial asymmetry, with a mean (SD) eFACE score of 49 (16). Type 2, identified in 47 patients (29%), represented symmetry throughout the face with a mean (SD) eFACE score of 58 (16), which was significantly less severe than type 1 (mean difference, 9 points [95% CI, 3.68-14.48 points]). Type 3, identified in 20 patients (13%), represented localized hypotonicity on the affected side, with a mean (SD) eFACE score of 55 (20). Clustering analysis of dynamic appearance did not yield clinically usable results.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study, clinically meaningful clusters of resting facial synkinesis phenotypes represent regional hypertonicity in most cases, symmetry in others, and regional hypotonicity in atypical cases. This phenotypic framework may be useful in systematically evaluating patients and devising static and dynamic surgical treatment strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaoto.2026.3142","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:00:29Z","timestamp":1792076429000},"source":"Crossref","is-referenced-by-count":1,"title":["Facial Synkinesis Resting Phenotypes and Surgical Implications"],"prefix":"10.1001","author":[{"given":"Sahejbir S.","family":"Bhatia","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine F.","family":"Johansen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devan R.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Rail","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina V.","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MinJae","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Clinical & Translational Sciences, Department of Internal Medicine, McGovern Medical School, UTHealth Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Tavares-Ferreira","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Center for Advanced Pain Studies, University of Texas at Dallas, Richardson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shai M.","family":"Rozen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"3","key":"ooi260060r1","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1159\/000008154","article-title":"The development of synkinesis after facial nerve paralysis.","volume":"43","author":"Celik","year":"2000","journal-title":"Eur Neurol"},{"issue":"3","key":"ooi260060r2","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1111\/coa.12799","article-title":"Synkinesis in Bell\u2019s palsy in a randomised controlled trial.","volume":"42","author":"Bylund","year":"2017","journal-title":"Clin Otolaryngol"},{"key":"ooi260060r3","doi-asserted-by":"publisher","DOI":"10.1089\/fpsam.2020.0082","article-title":"Degree of self-reported facial impairment correlates with social impairment in individuals with facial paralysis and synkinesis.","author":"Krane","year":"2020","journal-title":"Facial Plast Surg Aesthet Med"},{"issue":"5","key":"ooi260060r4","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1002\/ohn.936","article-title":"Chemodenervation is associated with reduced mental health disorders in patients with synkinesis.","volume":"171","author":"Lorenz","year":"2024","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ooi260060r5","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.79581","article-title":"Quantifying dynamic facial expressions under naturalistic conditions.","volume":"11","author":"Jeganathan","year":"2022","journal-title":"Elife"},{"issue":"1","key":"ooi260060r6","doi-asserted-by":"publisher","first-page":"12798","DOI":"10.1038\/s41598-024-62902-6","article-title":"Being facially expressive is socially advantageous.","volume":"14","author":"Kavanagh","year":"2024","journal-title":"Sci Rep"},{"issue":"2","key":"ooi260060r7","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1037\/a0035237","article-title":"Judgments of subtle facial expressions of emotion.","volume":"14","author":"Matsumoto","year":"2014","journal-title":"Emotion"},{"issue":"1","key":"ooi260060r8","doi-asserted-by":"publisher","first-page":"86e","DOI":"10.1097\/PRS.0000000000012243","article-title":"The natural progression of synkinesis.","volume":"157","author":"Rail","year":"2026","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"ooi260060r9","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1001\/jamaoto.2024.4489","article-title":"Clinical perspectives on the pathophysiology of facial synkinesis: a narrative review.","volume":"151","author":"Rail","year":"2025","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"9","key":"ooi260060r10","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1080\/00016489.2017.1316871","article-title":"Individualized management of facial synkinesis based on facial function.","volume":"137","author":"Maria","year":"2017","journal-title":"Acta Otolaryngol"},{"issue":"11","key":"ooi260060r11","doi-asserted-by":"publisher","first-page":"2513","DOI":"10.1002\/lary.24732","article-title":"Platysma synkinesis in facial palsy and botulinum toxin type A.","volume":"124","author":"Dall\u2019Angelo","year":"2014","journal-title":"Laryngoscope"},{"issue":"5","key":"ooi260060r12","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1097\/PRS.0000000000011345","article-title":"Negative impact of synkinetic mentalis muscle on smile quality: pathomechanism and treatment with mentalis-targeted selective neurectomies.","volume":"154","author":"Facchin","year":"2024","journal-title":"Plast Reconstr Surg"},{"issue":"6","key":"ooi260060r13","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1016\/j.otc.2018.07.012","article-title":"Surgical management of postparalysis facial palsy and synkinesis.","volume":"51","author":"Azizzadeh","year":"2018","journal-title":"Otolaryngol Clin North Am"},{"issue":"1","key":"ooi260060r14","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1080\/02688690410001660454","article-title":"After facial nerve damage, regenerating axons become aberrant throughout the length of the nerve and not only at the site of the lesion: an experimental study.","volume":"18","author":"Choi","year":"2004","journal-title":"Br J Neurosurg"},{"issue":"11","key":"ooi260060r15","doi-asserted-by":"publisher","first-page":"1847","DOI":"10.1288\/00005537-197911000-00020","article-title":"Mechanisms of synkinesis.","volume":"89","author":"Crumley","year":"1979","journal-title":"Laryngoscope"},{"key":"ooi260060r16","first-page":"1","article-title":"Axonal branching and recovery of coordinated muscle activity after transection of the facial nerve in adult rats.","volume":"180","author":"Angelov","year":"2005","journal-title":"Adv Anat Embryol Cell Biol"},{"issue":"2","key":"ooi260060r17","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1111\/j.1460-9568.2005.03877.x","article-title":"Factors limiting motor recovery after facial nerve transection in the rat: combined structural and functional analyses.","volume":"21","author":"Guntinas-Lichius","year":"2005","journal-title":"Eur J Neurosci"},{"key":"ooi260060r18","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.1019554","article-title":"Pathogenesis, diagnosis and therapy of facial synkinesis: a systematic review and clinical practice recommendations by the international head and neck scientific group.","volume":"13","author":"Guntinas-Lichius","year":"2022","journal-title":"Front Neurol"},{"issue":"3","key":"ooi260060r19","doi-asserted-by":"publisher","first-page":"203","DOI":"10.3233\/RNN-2011-0592","article-title":"Cortical reorganization in Bell\u2019s palsy.","volume":"29","author":"Klingner","year":"2011","journal-title":"Restor Neurol Neurosci"},{"issue":"4","key":"ooi260060r20","doi-asserted-by":"publisher","first-page":"573e","DOI":"10.1097\/PRS.0000000000012476","article-title":"OnabotulinumtoxinA versus surgery: evaluating patient treatment choices for postparalysis facial synkinesis.","volume":"157","author":"Bhatia","year":"2026","journal-title":"Plast Reconstr Surg"},{"issue":"2","key":"ooi260060r21","doi-asserted-by":"publisher","first-page":"223e","DOI":"10.1097\/PRS.0000000000001447","article-title":"Clinician-graded electronic facial paralysis assessment: the eFACE.","volume":"136","author":"Banks","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"424","key":"ooi260060r22","article-title":"Note sur les contractions \u201csyn\u00e9rgiques paradoxales\u201d observ\u00e9es \u00e0 la suite de la paralysie faciale p\u00e9riph\u00e9rique.","volume":"18","author":"Lamy","year":"1905","journal-title":"Nouv iconog de la Salp\u00eatri\u00e8re"},{"issue":"3","key":"ooi260060r23","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000000283","article-title":"Postparalysis facial synkinesis: clinical classification and surgical strategies.","volume":"3","author":"Chuang","year":"2015","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"6","key":"ooi260060r24","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1089\/fpsam.2022.0206","article-title":"Chemodenervation algorithm: functional and aesthetic considerations for facial harmony in patients with post-facial paralysis synkinesis.","volume":"25","author":"Hetzler","year":"2023","journal-title":"Facial Plast Surg Aesthet Med"},{"issue":"1","key":"ooi260060r25","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1089\/fpsam.2023.0351","article-title":"Facial aberrant reinnervation syndrome following facial nerve injury and recovery.","volume":"27","author":"Dey","year":"2025","journal-title":"Facial Plast Surg Aesthet Med"}],"container-title":["JAMA Otolaryngology\u2013Head & Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2855369\/jamaotolaryngology_bhatia_2026_oi_260060_1793118250.07255.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T15:00:16Z","timestamp":1793286016000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2855369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":25,"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2026.3142","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,15]]}}}