A 59-year-old man with a history of left facial nerve palsy 10 years prior presented with a progressive protrusion on the left side of his neck. An examination revealed a tense protrusion of the left platysma muscle at rest (Picture, arrows), with no involuntary movement during facial expressions, such as smiling or lip pursing. No other cranial nerve deficits were noted, and magnetic resonance imaging of the brain revealed no abnormalities. Given the history of facial nerve palsy and delayed-onset isolated platysma hypertonia, the presentation was consistent with facial aberrant reinnervation syndrome (FARS) involving the cervical branch of the facial nerve. FARS includes a broad spectrum of clinical symptoms, such as synkinesis (involuntary contraction of one muscle during voluntary movement of another), muscle hypertonicity (increased resting muscle tension), and spasms or twitching following facial nerve injury and regeneration (1). Platysma hypertonia is an often overlooked but clinically relevant manifestation of FARS, although its exact mechanism remains unclear (2). Treatment options include physiotherapy, botulinum toxin injection, or surgery.
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The author states that he has no Conflict of Interest (COI).
References
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