Facial tissue expansion is a routine method used to repair large areas of facial defects. However, complication rates are higher in the face than in the other parts of the body due to its unique neuromuscular distribution and dynamic nature. These include facial nerve injury manifested as transient facial nerve palsy as priorly reported. Herein, we report another type of facial nerve injury. Three cases of facial synkinesis were observed after buccal tissue expansion and skin flap transplantation for facial burn repair. During the follow-up period, there were no signs of improvement, suggesting that this may be an irreversible injury. Some hypotheses were made to discuss the probable factors driving this phenomenon, followed by strategies recommended to prevent this complication during the expansion procedure. Facial tissue expansion in the cheek may cause facial nerve injury and lead to facial synkinesis, by the persistent non-physiological strong pressure originating from the expander. Therefore, special attention should be given when surgeons consider placing the expander on the cheek.

Haitao Xiao has completed his MD from Sichuan University, China. He is the associate professor of burn and plastic surgery department of West China Hospital, China. He has 14 SCI publications.