Chief & Presenting Author: Dr.Afeefa Akhter

Co Author(s): Dr.Wajahat Rizvi

Abstract

Bell’s palsy is a common cause of facial nerve paralysis, characterised by sudden onset unilateral facial weakness, often attributed to inflammation or viral infection. While most patients recover spontaneously, some may develop aberrant regeneration of facial nerve leading to persistent symptoms such as synkinesis, hyperkinesis or facial asymmetry. We present a case of a 17-year-old female who developed moderate ptosis in RE post Bell’s Palsy with good LPS action. She underwent LPS resection post which her ptosis improved but later she developed Facial Nerve Synkinesis, where her eyes are symmetrical in primary gaze but her RE droops by 5 mm whenever she smiles. Through detailed clinical assessment, electromyography, and imaging studies, we identified axonal misdirection as the underlying mechanism. The patient was given targeted therapy of botulinum toxin injections for symptomatic relief and targeted physical therapy to optimize facial functions.