Synkinesis Between Orbicularis Oculi and Procerus Muscles: Video Presentation of an Unusual Type of Aberrant Innervation after Cosmetic Rhinoplasty

Overview

Synkinesis is unwanted linked movement, where activating one muscle also fires another because nerve fibers have regrown into the wrong place. It is well described after facial nerve paralysis. This case report documents a form not previously reported, linking the eyelid muscle to the muscle between the eyebrows after rhinoplasty.

Sections of note

• Interventional case report of two women, aged 42 and 37 years.
• Both presented with unilateral contraction of the medial eyebrow muscle, the procerus, on spontaneous or voluntary blinking.
• Onset was 4 and 5 months after cosmetic rhinoplasty respectively.
• Ocular-oral and oral-ocular synkinesis are described as the most common types; ocular-nasal synkinesis had been reported in two patients after cosmetic rhinoplasty.
• Synkinesis between the orbicularis oculi and procerus muscles had not been reported before this.
• Both patients were successfully treated with injection of botulinum toxin A.
• The authors recommend gentle tissue handling to minimize injury to fine motor branches of the facial nerve. Level of evidence V.

What it means for a patient

• Surgery near the root of the nose can injure small nerve branches, and regrowth can connect them to the wrong muscle.
• The result here was an eyebrow twitch that fired with every blink, appearing several months after surgery, not immediately.
• Botulinum toxin resolved it, but the authors describe that effect as temporary, so repeat treatment would be needed.
• Limits: two patients, so this documents that the complication can happen without indicating how often.

Why this paper matters

Nerve complications of rhinoplasty are rarely reported and easily missed because they appear months later. Naming a new pattern helps others recognize it. Nothing here indicates how common it is or whether it resolves on its own.

Terms

• Synkinesis: Involuntary movement of one muscle when a different one is activated.
• Orbicularis oculi: The ring of muscle around the eye that closes the eyelid.
• Procerus: The small muscle between the eyebrows over the root of the nose.
• Aberrant innervation: Nerve fibers regrowing into the wrong muscle after injury.
• Botulinum toxin A: An injected agent that temporarily blocks muscle contraction.