Surgical treatment of the synkinetic eyelid closure in Marin-Amat syndrome.

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.