ABSTRACT

INTRODUCTION. Synkinesis is reflex muscle contractions in response to voluntary activity of other muscles. When the peripheral nervous system is affected, they most often affect the craniofacial muscles and are associated with damage to the facial or  oculomotor nerves. This reduces the quality of life of patients, leading to functional limitations, cosmetic defects and psychological problems. The pathogenesis of this type of synkinesis is still poorly understood, and conventional rehabilitation methods often prove ineffective.

AIM. Based on literary data, to study the morpho-functional prerequisites for the development of synkinesis in lesions of the peripheral nervous system, to determine the role of trigger points in their pathogenesis and to evaluate the effectiveness of using peripheral synkinesis in rehabilitation methods.

MATERIALS AND METHODS. A systematic analysis of 98 publications from PubMed, Web of Science, Scopus and Google Scholar databases was conducted for the period from 2020 to 2025. Selection criteria included reviews, clinical studies and randomized controlled trials.

RESULTS AND DISCUSSION. Peripheral synkinesis is mainly associated with damage to the III, IV, VI and VII pairs of cranial nerves. Their main mechanism is aberrant axonal regeneration supplemented by ephaptic transmission, hyperexcitability of cranial nerve nuclei and cortical reorganization. The uniqueness of peripheral synkinesis is due to anatomical features: significant branching and short length of nerves, evolutionary resistance of extraocular and facial muscles to denervation and the presence of alternative sources of proprioception. Trigger points play a significant role in the pathogenesis of peripheral synkinesis, increasing the hyperexcitability of the brainstem nuclei, and their inactivation destroys this pathological system. In paralysis of facial muscles, true contractures are absent. Cicatricial and fatty degeneration have been described only in congenital defects of the innervation of the eye muscles.

CONCLUSION.
1. The prerequisites for peripheral synkinesis are the anatomical features of the III, IV, VI and VII pairs of craniofacial nerves and craniofacial muscles: strong branching and short length of nerves, acquisition of alternative sources of proprioception by extraocular and facial muscles during evolution.
2. Intensive trigger point formation in facial palsy is an early marker of denervation that can worsen synkinesis. They need to be inactivated.
3. With denervation of facial muscles, true contractures do not occur. Sometimes tonic synkinesis such as spastic hemifacial contracture or myokymia are mistaken for them.
4. The use of peripheral synkinesis for rehabilitation has no pathogenetic justification. 

KEYWORDS: synkinesis, facial muscles, extraocular muscles, masticatory muscles, proprioceptors, denervation, regeneration, trigger points

For citation: Petrov K.B., Mitichkina T.V. Craniofacial Synkinesis: Features of Proprioception and Denervation. A Review. Comorbidity Neurology. 2026; 3 (1): 31–42. https://doi.org/10.62505/3034-185x-2026-3-1-31-42

*For correspondence: Konstantin B. Petrov, Dr. Sci. (Med.), Professor, Head of the Department of Physical Therapy, Novokuznetsk State Institute of Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia, e-mail: 79059109919@yandex.ru.

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ADDITIONAL INFORMATION

Konstantin B. Petrov, Dr. Sci. (Med.), Professor, Head of the Department of Physical Therapy, Novokuznetsk State Institute of Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia. E-mail: 79059109919@yandex.ru. ORСID: http://orcid.org/0000-0001-6246-8811

Tatiana V. Mitichkina, Ph.D., Sci. (Med.), Associate Professor of the Department of Physical Therapy, Novokuznetsk State Institute of Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia. E-mail: tanya_mi2005@mail.ru. ORСID: https://orcid.org/0000-0001-6510-0369

Author contributions. All authors confirm the compliance of their authorship, according to international ICMJE criteria (all authors made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). Special contributions: Mitichkina T.V. – data curation, formal analysis; Petrov K.B. – supervision, writing – review & editing, writing – original draft.

Funding. This study was not supported by any external sources of funding.

Disclosure. The authors declare no apparent or potential conflicts of interest related to the publication of this article.

The content is available under the Creative Commons Attribution 4.0 License.

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