Surgical Treatment of the Synkinetic Eyelid Closure in Marin-Amat Syndrome

Abstract

Marin-Amat syndrome is a synkinesis which develops following facial nerve palsy and manifests as an involuntary eyelid closure when the jaw is opened. We presented 2 patients with Marin-Amat syndrome. One patient developed this syndrome after Bell palsy and the other after cross-facial nerve graft and free functional muscle transfer. Surgery was planned with an attempt to resect the target muscle innervated by the aberrant nerve to eliminate the paradoxical synkinesis. We developed a new surgical technique by resection of the upper or lower preseptal orbicularis oculi muscle (OOM) to treat the synkinetic eyelid closure effectively in both cases. Since the pretarsal and orbital OOM remain intake, patients can close their eyes smoothly. No recurrence or any sequela was noted after long-term follow-up. Careful preoperative electromyography study and detailed dynamic facial image analysis of both upper and lower lid OOM are very important to locate the synkinetic muscle. To the best of our knowledge, this is the first report to treat Marin-Amat syndrome successfully with surgical resection of preseptal OOM.

Marin-Amat Sendromu

“…The most common treatment modalities for patients with Marin-Amat syndrome today are: Botulinum toxin type A injection, facial neuromuscular training, biofeedback method, selective neurolysis or myectomy [6]. Botulismus toxin treatment may be beneficial on blepharospasm [6,7].…”

Marin-Amat syndrome: a case of acquired facial synkinesis

“…The mechanism of synkinesis are different in both, and the term inverse Marcus-Gunn syndrome should be reserved only for a congenital lesion, where the mechanism of lid closure is because of inhibition of the levator palpebrae superioris rather than orbicularis oculi contraction as seen in Marin-Amat syndrome (figure 1). 1 2 Most patients with minor cosmetic deformity do not need treatment, but in some cases botulinum toxin or eyelid surgery may be helpful 3…”

Mari̇n-Amat Sendromu: Olgu Sunumu

“…Marin-Amat sendromunda çenenin açılması veya laterale hareketi ile etkilenen göz kapağında blefarospazm sonucunda kapanma ortaya çıkar. Genellikle edinseldir ve periferik fasiyal paralizi sonrası gelişir (2,3,4,7). Birçok kas grubunu innerve eden akson dallanması ile birlikte, 7. sinirin aberan rejenerasyonu ve 5 ve 7. sinirler arasındaki hatalı inervasyonun bu sendromdan sorumlu olabileceği ileri sürülmüştür (2).…”

“…Marin-Amat sendromlu hastalarda, botulismus toksin tedavisi blefarospazm üzerinde yararlı olabilir (2). Ayrıca preseptal orbicularis okuli kasının rezeksiyonunun da başarılı olduğu bildirilmiştir (7).…”