Background and objectives : Since botulinum toxin type A (BTX-A) was suggested for the treatment of facial synkinesis, it has been widely used to treat such an unwanted, involuntary movement of the affected side induced by unhealthy aberrant neural regeneration. But we experienced unexpected complications to some patients after BTX-A injection for correction of facial synkinesis (ptosis, pseudo Bell’s palsy, and diplopia). We conducted detailed analysis to reduce these complications after injection. Materials and methods : From May 2010 to June 2013, we conducted BTX-A injection for facial synkinesis of 72 patients, and experienced unexpected complications in 7 patients after BTX-A injection for facial synkinesis. In retrospective analysis, 4 patients had ptosis, 2 patients had pseudo Bell’s palsy, 1 patient had diplopia after BTX-A injection. We analyzed injected dosage, points of injection, and also analyzed patient’s age, duration of facial paralysis. Results : The high frequency (6%) of ptosis was induced by an overdose of BTX-A injection compared to small muscular volume of the palpebral part of orbicularis oculi muscle and by an inappropriate point near the eyebrow within 1cm. Pseudo Bell’s palsy was shown to two patients with old age (>65) who were injected below zygomatic arch which had made transient paralysis of zygomaticus major or minor muscles. Conclusion : With awareness of danger space and dosage variations for BTX-A injection, we can control facial synkinesis with ease.
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