DR.MOHAMMED IRFAN SHEIKHabout 1 year ago

Marin-Amat Syndrome

Intrafacial Synkinesis A 52-year-old man was admitted to the hospital with weakness that had progressed over a period of several weeks. Cranial-nerve examination revealed involuntary unilateral ptosis that coincided with voluntary contraction of the lower facial muscles, a form of synkinesis known as the Marin-Amat syndrome (see video). Symmetric proximal muscle weakness was present, and Gottron’s papules were also observed over the dorsum of the metacarpophalangeal joints. Laboratory data were notable for an elevated serum creatine kinase level of 51,000 U per liter (normal range, 55 to 170). A diagnosis of dermatomyositis was made; however, the finding of synkinesis could not be explained by dermatomyositis. Further medical history was obtained, and the patient described an episode of Bell’s palsy that had occurred several years before this admission and that had affected the left side of his face. Synkinesis describes the involuntary movement of a muscle that occurs with the voluntary movement of a different muscle. The Marin-Amat syndrome, a specific form of intrafacial synkinesis, describes the contraction of the orbicularis oculi muscle with the movement of the lower facial muscles. It is thought to develop primarily as a result of aberrant regeneration of nerve fibers after traumatic injury and can be a sequela of Bell’s palsy. Treatment options for synkinesis include facial neuromuscular retraining and injection of botulinum toxin. Outpatient referral for the consideration of one or more of these therapies was arranged for this patient.