Hyperkinesias after hypoglossofacial nerve anastomosis--treatment with botulinum toxin

Hypoglossofacial nerve anastomosis is a successful method for restoration of facial nerve function. Facial hyperkinesis, however, are a common side effect of this therapy and have been a major therapeutical problem ever since. We are reporting a patient whose facial hyperkinesias responded favourably to botulinum toxin carefully injected into the most affected muscles. EMG studies are illustrating the effect of botulinum toxin on the facial hyperkinesias as well as on voluntary muscle activation.