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Sanchez-Cuadrado I, Mato-Patino T, Morales-Puebla JM, Peñarrocha J, Diez-Sebastian J, Gavilán J, Lassaletta L. Validation of the Spanish version of the Sunnybrook facial grading system. Eur Arch Otorhinolaryngol 2023; 280:543-548. [PMID: 35737100 DOI: 10.1007/s00405-022-07484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/31/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The Sunnybrook facial grading system (SFGS) is one of the most widely employed tools to assess facial function. The present study aimed to determine the validity and reliability of the Spanish language version of the SFGS. METHODS Forward-backward translation from the original English version was performed by fluent speakers of English and Spanish. Videos from 65 patients with facial paralysis (FP) were evaluated twice by five otolaryngologists with experience in FP evaluation. Internal consistency and intra- and inter-rater reliability were assessed. The House-Brackmann scale was used to display concurrent validity which was established by Spearman's rho correlation. RESULTS The Cronbach's α score exceeded 0.70. The intra-rater intraclass correlation coefficient (ICC) was nearly perfect for the composite score (0.96-0.99), voluntary movements (0.97-0.99), and synkinesis (0.91-0.98), and important to almost perfect for symmetry at rest (0.79-0.97). In both evaluations, the inter-rater ICC was higher than 0.90 for the composite score (0.92-0.96) and voluntary movements (0.91-0.96) and slightly lower for symmetry at rest (0.66-0.85) and synkinesis (0.72-0.87). A strong negative correlation was found between the H-B scale and SFGS (Spearman's rho coefficient = - 0.92, p < 0.001) in both evaluations. CONCLUSION The Spanish version of the SFGS is a reliable and valuable instrument for the assessment of facial function in the diagnosis and treatment of patients with FP.
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Affiliation(s)
- Isabel Sanchez-Cuadrado
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain. .,IdiPAZ Research Institute, Madrid, Spain.
| | - Teresa Mato-Patino
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III (CIBERER-U761), Madrid, Spain
| | - Julio Peñarrocha
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain
| | | | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III (CIBERER-U761), Madrid, Spain
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Kuttenreich AM, von Piekartz H, Heim S. Is There a Difference in Facial Emotion Recognition after Stroke with vs. without Central Facial Paresis? Diagnostics (Basel) 2022; 12:diagnostics12071721. [PMID: 35885625 PMCID: PMC9325259 DOI: 10.3390/diagnostics12071721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/06/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022] Open
Abstract
The Facial Feedback Hypothesis (FFH) states that facial emotion recognition is based on the imitation of facial emotional expressions and the processing of physiological feedback. In the light of limited and contradictory evidence, this hypothesis is still being debated. Therefore, in the present study, emotion recognition was tested in patients with central facial paresis after stroke. Performance in facial vs. auditory emotion recognition was assessed in patients with vs. without facial paresis. The accuracy of objective facial emotion recognition was significantly lower in patients with vs. without facial paresis and also in comparison to healthy controls. Moreover, for patients with facial paresis, the accuracy measure for facial emotion recognition was significantly worse than that for auditory emotion recognition. Finally, in patients with facial paresis, the subjective judgements of their own facial emotion recognition abilities differed strongly from their objective performances. This pattern of results demonstrates a specific deficit in facial emotion recognition in central facial paresis and thus provides support for the FFH and points out certain effects of stroke.
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Affiliation(s)
- Anna-Maria Kuttenreich
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany;
- Department of Neurology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Center of Rare Diseases Jena, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Correspondence: ; Tel.: +49-3641-9329398
| | - Harry von Piekartz
- Department of Physical Therapy and Rehabilitation Science, Osnabrück University of Applied Sciences, Albrechtstr. 30, 49076 Osnabrück, Germany;
| | - Stefan Heim
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany;
- Department of Neurology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
- Institute of Neuroscience and Medicine (INM−1), Forschungszentrum Jülich, Leo-Brand-Str. 5, 52428 Jülich, Germany
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Facial Emotion Recognition in Patients with Post-Paralytic Facial Synkinesis—A Present Competence. Diagnostics (Basel) 2022; 12:diagnostics12051138. [PMID: 35626294 PMCID: PMC9139660 DOI: 10.3390/diagnostics12051138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Facial palsy is a movement disorder with impacts on verbal and nonverbal communication. The aim of this study is to investigate the effects of post-paralytic facial synkinesis on facial emotion recognition. In a prospective cross-sectional study, we compared facial emotion recognition between n = 30 patients with post-paralytic facial synkinesis (mean disease time: 1581 ± 1237 days) and n = 30 healthy controls matched in sex, age, and education level. Facial emotion recognition was measured by the Myfacetraining Program. As an intra-individual control condition, auditory emotion recognition was assessed via Montreal Affective Voices. Moreover, self-assessed emotion recognition was studied with questionnaires. In facial as well as auditory emotion recognition, on average, there was no significant difference between patients and healthy controls. The outcomes of the measurements as well as the self-reports were comparable between patients and healthy controls. In contrast to previous studies in patients with peripheral and central facial palsy, these results indicate unimpaired ability for facial emotion recognition. Only in single patients with pronounced facial asymmetry and severe facial synkinesis was an impaired facial and auditory emotion recognition detected. Further studies should compare emotion recognition in patients with pronounced facial asymmetry in acute and chronic peripheral paralysis and central and peripheral facial palsy.
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Thielker J, Kouka M, Guntinas-Lichius O. [Preservation, reconstruction, and rehabilitation of the facial nerve]. HNO 2022; 71:232-242. [PMID: 35288765 PMCID: PMC8920054 DOI: 10.1007/s00106-022-01148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/12/2022]
Abstract
Der Umgang mit dem N. facialis ist bei der Operation eines Parotiskarzinoms wichtig für die Langzeitlebensqualität des Patienten. In etwa 2 Drittel der Fälle ist der N. facialis nicht vom Tumor befallen. In diesen Fällen sind neben vollständiger Tumorentfernung die Identifizierung und der Erhalt des Nervs für eine erfolgreiche Operation wesentlich. Ist der Nerv vom Tumor infiltriert, muss der betroffene Teil des Nervs im Rahmen einer radikalen Parotidektomie reseziert werden. Die primäre Nervenrekonstruktion, sofern möglich, führt zu den besten funktionellen und kosmetischen Langzeitergebnissen. Das individuell optimale Therapiekonzept basiert zum einen auf der klinischen Prüfung der Gesichtsbeweglichkeit, zum anderen auf der präoperativen Bildgebung, um die Lagebeziehung zwischen Tumor und Nerv zu verstehen, und schließlich auf einer elektrophysiologischen Untersuchung zur Funktion des Nervs. Intraoperativ hilft ein standardisiertes Vorgehen, um den Nerv zu identifizieren und zu erhalten. Wenn eine radikale Parotidektomie indiziert ist, kann bereits die präoperative Diagnostik helfen, neben der einzeitigen Rekonstruktion auch die adjuvante postoperative Therapie zu planen. Das Ziel der Rehabilitation ist die Wiederherstellung von Tonus, Symmetrie und Bewegung des gelähmten Gesichts. Die Wiederherstellung des Augenschlusses hat hohe Priorität. Bei der chirurgischen Therapie von Gesichtslähmungen gab es in den letzten Jahren viele Verbesserungen. Die vorliegende Arbeit gibt einen Überblick über die jüngsten Fortschritte in der Diagnostik, den Operationstechniken und weiteren Möglichkeiten zur Protektion des gesunden N. facialis. Anderseits wird die Rehabilitation des tumorinfiltrierten N. facialis im Kontext der Behandlung von Speicheldrüsenmalignomen beschrieben.
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Affiliation(s)
- Jovanna Thielker
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland
| | - Mussab Kouka
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland
| | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland. .,Fazialis-Nerv-Zentrum, Universitätsklinikum Jena, Jena, Deutschland.
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Thielker J, Kuttenreich AM, Volk GF, Guntinas-Lichius O. [Diagnostics and Therapy of Idiopathic Facial Palsy (Bell's Palsy)]. Laryngorhinootologie 2021; 100:1004-1018. [PMID: 34826861 DOI: 10.1055/a-1529-3582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this review is to report the knowledge for otolaryngologists on standard of care, latest advances, interesting new findings and controversies about the treatment of Bell's palsy. This review is focusing on the acute phase of the disease. The chronic phase, with incomplete, incorrect or no recovery of the palsy, is described briefly. Treatment with prednisolone alone within 72 hours after onset still is the cornerstone of the treatment. The role of antivirals still is unclear. Since 2009 no new and breakthrough clinical trials with influence on the treatment standards have been performed. A study to clarify the role of prednisolone treatment in children is ongoing. Patient-related outcome measures like the Facial Clinimetric Evaluation Scale and the Facial Disability Index are important tools to assess the subjective severity of the disease and psychosocial impact of Bell's palsy next to the motor deficits. Simplified subjective electronic grading systems like the eFACE and first automated image analysis systems have been introduced. Studies clarifying the role of antivirals for severe cases are urgently needed as well as studies on the role of salvage second line therapy after insufficient response to initial corticosteroid treatment. An international consensus on the outcome measures in diagnostics and follow-up is also needed.
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Affiliation(s)
| | | | | | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Jena, Germany
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Mengi E, Kara CO, Ardiç FN, Tümkaya F, Barlay F, Çil T, Şenol H. Validation of the Turkish version of the Sunnybrook facial grading system. Turk J Med Sci 2020; 50:478-484. [PMID: 32041382 PMCID: PMC7164749 DOI: 10.3906/sag-1905-195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 02/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background/aim To adapt the Sunnybrook facial grading system (SFGS) into Turkish and perform validation and reliability studies on the Turkish version. Materials and Methods The original English version of the SFGS was translated into Turkish by performing a linguistic validity study based on international standards. The evaluators comprised 6 physicians. Evaluations were performed twice independently using the video recordings of 65 facial palsy patients. Synchronously, the House-Brackman facial grading system (HBFGS) was filled out to display concurrent validity. The intraclass correlation coefficient (ICC) and Cronbach’s alpha was used for the examination of the inter- and intra-rater reliability. As another indication of reliability, the generalizability (G) was also examined. Results The ICC for the inter-rater reliability for resting symmetry, symmetry of voluntary movement, synkinesis, and the composite score, which are 4 components of the SFGS, were determined, respectively, as 0.822, 0.956, 0.606, and 0.957 for the first evaluation, and 0.805, 0.965, 0.584, and 0.965 for the second evaluation. For the intra-rater reliability, the ICC were determined as 0.842, 0.956, 0.794, and 0.937, while the Cronbach’s alpha coefficients were determined as 0.809, 0.956, 0.792, and 0.948, respectively. The G coefficient was determined as G = 0.772. For the concurrent validity, a strong correlation was found between the SFGS and HBFGS scores. Conclusion The present study adapted the SFGS into Turkish, and demonstrated that the adapted scale was valid and reliable. The Turkish version can be used for the evaluation of facial palsy, the follow-up of treatment efficiency, and standardization in reporting outcomes with the international literature.
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Affiliation(s)
- Erdem Mengi
- Department of Otorhinolaryngology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Cüneyt Orhan Kara
- Department of Otorhinolaryngology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Fazil Necdet Ardiç
- Department of Otorhinolaryngology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Funda Tümkaya
- Department of Otorhinolaryngology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Fevzi Barlay
- Department of Otorhinolaryngology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Taylan Çil
- Department of Otorhinolaryngology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Hande Şenol
- Department of Biostatistics, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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