The Medical Minute: Specialized treatment helped patient smile again

HERSHEY, Pa. — Brittani Snyder, of York, never imagined a tick bite would change her life. A few weeks after she was bitten in July 2025, she woke up unable to move the left side of her face. She rushed to the emergency room, sure she was having a stroke. Doctors ruled out stroke and diagnosed Bell’s palsy, a form of facial paralysis without an identifiable cause. Later, testing showed she had Lyme disease from a tick bite, which likely caused her facial nerve damage.

Snyder was prescribed antibiotics, an antiviral medication and a steroid. At first, her symptoms improved, but three months later, her face began to twitch, and movement became uneven. The 36-year-old real estate agent was referred to the Penn State Health Facial Nerve Clinic, where Jessyka Lighthall quickly diagnosed the real problem: facial synkinesis.

The chronic condition affects up to half of people who experience facial nerve paralysis.

Why facial paralysis happens

Synkinesis can develop after facial paralysis when nerves heal incorrectly. The nerves “misfire,” causing facial muscles to twitch, tighten or move in unintended ways.

“Synkinesis is like being fish-hooked. The nerves are working overtime and constantly pulling,” Snyder said. “The muscles were especially pulling to the right, which made my facial symmetry look off.”

Lighthall, division chief of facial plastic and reconstructive surgery at Penn State Health, explained that facial paralysis can have many causes, including stroke, tumors, trauma, infections and Lyme disease. Bell’s palsy is a specific diagnosis made only after other causes have been ruled out.

“With Bell’s palsy, some patients will eventually go back to normal, but many patients never fully recover function,” she said.

Lighthall said synkinesis means the nerves are miswired.

“The eye might close when eating, laughing or pursing the lips, or the mouth and neck may twitch and pull when blinking," Lighthall said. "It’s abnormal cross-talk and nerve regrowth.”

For Snyder, smiling, laughing or eating often caused one eye to close involuntarily. Her eyes are also more prone to excessive tearing, which leads her to wear sunglasses, as she describes on Instagram where she shares her recovery and daily life with synkinesis.

Relief through specialized treatment

Facial synkinesis has no known cure. However, Lighthall and her team offer multiple treatments to improve function and quality of life, including injections, specialized facial nerve therapy and surgery when appropriate.

Snyder’s treatment plan includes Botox injections to help relax overactive muscle movement on the affected side of her face, as well as the unaffected side, to create better facial symmetry and reduce unwanted contractions. Snyder sees Lighthall every three months and said she has made progress with each session.

“It’s a slow process. She uses a very small dosage and figures out what’s working and what’s not. We adjust it each time,” Snyder said.

After three injection sessions, Snyder can now keep her eye open while eating, smiling and laughing. Her facial balance and function have also improved.

Snyder’s care includes facial neuromuscular retraining from Nicole Fisher, a speech-language pathologist specializing in facial nerve therapy, who has been with the Facial Nerve Clinic since it opened 10 years ago. Fisher develops individualized exercise programs to relax overstimulated facial muscles and help patients regain control of abnormal facial movements.

“Synkinesis is an overworked muscle that becomes tight and has limited motion,” Fisher said. “With Brittani, we’re decreasing muscle tightness, as well as increasing range of motion and lengthening the muscle. Depending on where patients are in their journey, the exercises and their program are very different.”

Snyder starts every morning with her facial exercises and repeats them several times a day. She said they have made a significant difference in her appearance and comfort level.

Rebuilding function and confidence

Facial nerve disorders affect more than physical appearance, Lighthall and Fisher said. They can also take a significant emotional toll.

“Facial weakness, palsies and facial nerve disorders have a psychosocial effect because everyone’s looking at your face, and when your face looks different, people are very self-conscious about it,” Fisher said. “Many people don’t want to go to work or go out or eat in front of people. Our clinic tries to address the whole patient.”

This year marks the 10th anniversary of the Penn State Health Facial Nerve Clinic. A new Facial Nerve Patient Support Group will launch in the coming months to help patients connect with others people who share similar experiences. For Snyder, the coordinated care she’s received has helped her regain her confidence and adapt to life with a chronic diagnosis.

“There’s no reversing my condition, even with injections and exercises,” Snyder said. “But between the two of them, it’s dramatically helped and improved.”

Related content:

• Video: Santa Gets His Smile Back: How Jeffrey Schott Recovered from Facial Paralysis
• The Medical Minute: Know the risks from ticks this summer
• Video: Facial Nerve Clinic – Jessyka Lighthall, Facial Plastic and Reconstructive Surgery

The Medical Minute is a health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.