The Impact of Surgical and Nonsurgical Interventions on Overall Oral, Palpebral Fissure, and Brow Height Symmetry in a Patient with Facial Synkinesis.

Background: The treatment of facial nerve synkinesis remains complex and variable. Objective: To compare oral, palpebral fissure, and brow symmetry among surgical and nonsurgical interventions in patients with facial synkinesis. Methods: Patients with facial nerve synkinesis at a single tertiary care center between 2008 and 2022 were analyzed before and after interventions using Emotrics software. Symmetry was compared among treatment combination groups (chemodenervation and rehabilitation [CR] vs. chemodenervation and surgery [CS] vs. chemodenervation, surgery, and rehabilitation [CSR]) and among surgical intervention groups (selective neurectomy [SN] vs. selective neurectomy with facelift [SnFa] vs. no surgery). Results: Of the 29 patients meeting inclusion criteria, 72.4% were female and the median age was 60.6 years (interquartile range 49.9-67.6). The median follow-up was 32.6 months; patients who received surgery had a greater follow-up time (57.4 months vs. 26.5 months, p = 0.045). The use of a trimodal approach (CSR) was associated with improved symmetry versus CR for smile angle (p = 0.021). Among surgical interventions, the greatest improvement in palpebral fissure symmetry was in patients who received SN versus no surgery (p = 0.039); the greatest improvement in smile angle was in patients who received SnFa versus no surgery (p = 0.008). Conclusion: We recommend a comprehensive approach to the management of facial synkinesis consisting of chemodenervation, rehabilitation, and surgery tailored to each patient's needs.

Comprehension of televised stories in boys with attention deficit/hyperactivity disorder and nonreferred boys.

Two studies compared comprehension of televised stories by 7- to 12-year-old boys with attention deficit/hyperactivity disorder (ADHD) and nonreferred comparison boys. Boys watched one show with toys present and one with toys absent. Visual attention was continuously recorded, and recall was tested after each show. Across studies, visual attention was high with toys absent but decreased sharply with toys present for boys with ADHD. Groups showed similar levels of cued recall of discrete units of information regardless of differences in attention. When recall tasks and television story structure required knowledge of relations among events, the reduced attention of boys with ADHD interfered with recall. Although visual attention of comparison boys also decreased to some extent with toys present, there was no such decrement in recall. Implications of the difficulties children with ADHD have in integrated story comprehension are discussed.