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Shamil E, Noriega M, Moin S, Ko TK, Tan DJY, Meller C, Andrews P, Lekakis G. Psychological Aspects of Facial Palsy. Facial Plast Surg 2024. [PMID: 38648794 DOI: 10.1055/s-0044-1782678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
This article discusses the psychological effects of facial palsy (FP) in adults. FP is the abnormal functioning of facial muscles resulting from temporary or permanent damage of the facial nerves. Following facial paralysis, patients can develop motor and psychosocial functioning issues impacting quality of life. In addition, real or perceived judgment in social settings of those with FP increases the risk of low self-esteem, anxiety, and depression. Currently, most available research focuses on surgical patients and suggests a lack of psychological support throughout the affliction. A multidisciplinary approach when treating patients with FP can help improve the patient's quality of life.
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Affiliation(s)
- Eamon Shamil
- Department of ENT Surgery, Prince of Wales Hospital, Sydney, Australia
- Department of ENT Surgery, The Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Maria Noriega
- Department of ENT Surgery, The Royal National ENT Hospital, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Sarah Moin
- Department of ENT Surgery, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, United Kingdom
| | - Tsz Ki Ko
- Department of ENT Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Denise Jia Yun Tan
- Department of ENT Surgery, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Catherine Meller
- Department of ENT Surgery, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Peter Andrews
- Department of ENT Surgery, Royal National ENT and Eastman Dental Hospitals, London, United Kingdom
| | - Garyfalia Lekakis
- Department of ENT Surgery, Hôpitaux Iris Sud HIS, Brussels, Belgium
- University Hospitals Leuven, Leuven, BE, Louise Medical Center, Bruxelles, Belgium
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Schutte H, Bielevelt F, Muradin MSM, Bleys RLAW, Rosenberg AJWP. New method for analysing spatial relationships of facial muscles on MRI: a pilot study. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00058-4. [PMID: 38565453 DOI: 10.1016/j.ijom.2024.03.003] [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: 09/28/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Dysfunction of the facial musculature can have significant physical, social, and psychological consequences. In surgeries such as cleft surgery or craniofacial bimaxillary osteotomies, the perioral facial muscles may be detached or severed, potentially altering their functional vectors and mimicry capabilities. Ensuring correct reconstruction and maintenance of anatomical sites and muscle vectors is crucial in these procedures. However, a standardized method for perioperative assessment of the facial musculature and function is currently lacking. The aim of this study was to develop a workflow to analyse the three-dimensional vectors of the facial musculature using magnetic resonance imaging (MRI) scans. A protocol for localizing the origins and insertions of these muscles was established. The protocol was implemented using the 3DMedX computer program and tested on 7 Tesla MRI scans obtained from 10 healthy volunteers. Inter- and intra-observer variability were assessed to validate the protocol. The absolute intra-observer variability was 2.6 mm (standard deviation 2.0 mm), and absolute inter-observer variability was 2.6 mm (standard deviation 1.5 mm). This study presents a reliable and reproducible method for analysing the spatial relationships and functional significance of the facial muscles. The workflow developed facilitates perioperative assessment of the facial musculature, potentially aiding clinicians in surgical planning and potentially enhancing the outcomes of midface surgery.
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Affiliation(s)
- H Schutte
- Department of Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - F Bielevelt
- Department of Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Radboud University Medical Centre, Radboudumc 3D Lab, Nijmegen, the Netherlands
| | - M S M Muradin
- Department of Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R L A W Bleys
- Department of Functional Anatomy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A J W P Rosenberg
- Department of Maxillofacial Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Nowacka A, Barker-Collo S, Miles A. Exploring the influence of appearance evaluation apprehension: How fear of negative evaluation affects quality of life in people with Vestibular Schwannoma. J Clin Neurosci 2024; 123:7-12. [PMID: 38508019 DOI: 10.1016/j.jocn.2024.03.011] [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: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
People diagnosed with Vestibular Schwannoma (VS) can experience several symptoms both pre and post-treatment. These, alongside the diagnosis experience, can significantly impact their daily life. The present research is a continuation of a larger study aiming to explore the impacts of symptomology and body image/fear of negative evaluation (FNAE) on the quality of life (QOL) for people with VS. The research design was exploratory and involved a nationwide survey with a total of 52 participants. FNAE was assessed using a measurement of the same name, and QOL was assessed using the Penn Acoustic Neuroma Quality of Life scale (PANQOL). Comparing management groups revealed a significant difference in FNAE with higher scores for surgery compared to radiation treatment. Regression analyses revealed that FNAE significantly accounted for 10.9% of the variance in QOL. However, no symptom was significantly predictive of FNAE. In conclusion, VS is associated with several symptoms that can persist post-treatment. Body satisfaction contributes to QOL and may differ between management types. However, due to inconclusive findings on the predictability of symptoms on FNAE, other moderator factors could influence these direct relationships. Future studies should evaluate the variables that could mitigate or protect from the impacts of FNAE for this population.
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Affiliation(s)
- Alicja Nowacka
- School of Psychology, The University of Auckland, Auckland, New Zealand.
| | - Suzanne Barker-Collo
- Clinical Training Programme, School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Anna Miles
- Speech Science, School of Psychology, The University of Auckland, Auckland, New Zealand
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Hamdi OA, Jones MK, Ziegler J, Basu A, Oyer SL. Hypoglossal Nerve Transfer for Facial Nerve Paralysis: A Systematic Review and Meta-Analysis. Facial Plast Surg Aesthet Med 2024; 26:219-227. [PMID: 38153410 DOI: 10.1089/fpsam.2023.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background: Hypoglossal-facial nerve (12-7) anastomosis can restore symmetry and voluntary movement on the face in patients with facial nerve paralysis. Traditional 12-7 transfer includes direct end-to-end nerve anastomosis, sacrificing the entire hypoglossal nerve. Contemporary, end-to-side anastomosis, or split anastomosis techniques limit tongue morbidity by preserving some hypoglossal nerve. Direct outcome comparisons between these techniques are limited. Objective: To compare reported outcomes of facial movement, tongue, speech, and swallow outcomes among the different types of hypoglossal-facial nerve anastomosis schemes. Evidence Review: For this systematic review and meta-analysis, a comprehensive strategy was designed to search PubMed, Scopus, and the Cochrane Database from inception to January 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, reporting guideline yielding 383 results. Any participant who underwent 12-7 transfer using any of the three techniques, with or without an interposition graft, and had documented preoperative and postoperative evaluation of facial nerve function with a validated instrument such as House-Brackmann (HB), was considered for inclusion. Secondary outcomes of synkinesis, tongue atrophy, and speech or swallowing dysfunction were also compared. Forty-nine studies met inclusion criteria, representing data from 961 total patients who underwent 12-7 transfer. Results: The proportion of good HB outcomes (HB I-III) did not differ by anastomosis type: End-to-side and end-to-end anastomosis (73% vs. 59%, p = 0.07), split and end-to-end anastomosis (62% vs. 59%, p = 0.88), and end-to-side anastomosis and split anastomosis (73% vs. 62%, p = 0.46). There was no difference in reported synkinesis rates between the anastomosis types. However, end-to-side anastomosis (z = 6.55, p < 0.01) and split anastomosis (z = 3.58, p < 0.01) developed less tongue atrophy than end-to-end anastomosis. End-to-side anastomosis had less speech/swallowing dysfunction than end-to-end anastomosis (z = 3.21, p < 0.01). Conclusion: End-to-side and split anastomoses result in similar HB facial nerve outcomes as the traditional end-to-end 12-7 anastomosis. End-to-side anastomosis has decreased complications of tongue atrophy and speech/swallow dysfunction compared to end-to-end anastomosis. In addition, split anastomosis has decreased rates of tongue atrophy compared to end-to-end anastomosis.
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Affiliation(s)
- Osama A Hamdi
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Marieke K Jones
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - John Ziegler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Annesha Basu
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel L Oyer
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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Machetanz K, Oberle L, Wang SS, Weinbrenner E, Gorbachuk M, Lauer H, Daigeler A, Tatagiba M, Naros G, Schäfer RC. Outpatient care for facial palsy-a survey on patient satisfaction in uni- and interdisciplinary approaches. Front Neurol 2024; 15:1354583. [PMID: 38385047 PMCID: PMC10880734 DOI: 10.3389/fneur.2024.1354583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
Objective The various causes of facial palsy, diagnostic methods and treatment approaches frequently involve different medical specialities. Nevertheless, there exist only few specialized consultation and therapy services for patients with facial palsy (FP) in Germany. The aim of the present study was to evaluate factors affecting quality of life (QoL) and treatment satisfaction of patients presenting to an interdisciplinary facial nerve outpatient clinic. Methods The study analyzed patients presenting to the interdisciplinary facial palsy outpatient clinic in Tuebingen between February 2019 and December 2022. General satisfaction and QoL was estimated by numerous self-rating questionnaires: ZUF-8, SF-36, FDI, FaCE, PHQ-9. An ANOVA was performed to analyze determinants affecting the ZUF-8. Correlation analyses between cause and regeneration of FP as well as questionnaire scores were performed. Results were compared with a group of patients who were managed in an unidisciplinary setting. Results In total, 66 patients with FP were enrolled. FP patients showed increased levels of depression (PHQ-9: 14.52 ± 3.8) correlating with recovery of the palsy (p = 0.008), FaCE (p < 0.001) and FDI ratings (p < 0.001). There was a high level of satisfaction with the services provided during the uni-and interdisciplinary consultation (ZUF-8: 24.59 ± 6.2), especially among the 12/66 patients who received reconstructive, surgical treatment. However, some patients requested more psychological and ophthalmological support. Conclusion High levels of treatment satisfaction can be achieved in both an uni-and interdisciplinary setting. However, multimodal therapy approaches should be applied, considering physical and psychological aspects. In the absence of recovery, surgical interventions must be considered as treatment options. Further studies should continue to investigate potential differences between uni-and interdisciplinary treatment.
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Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Linda Oberle
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Sophie S. Wang
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Eliane Weinbrenner
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Mykola Gorbachuk
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Henrik Lauer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Georgios Naros
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Ruth C. Schäfer
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Unfallklinik Tuebingen, Tuebingen, Germany
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Machetanz K, Wang SS, Oberle L, Tatagiba M, Naros G. Sex Differences in Vestibular Schwannoma. Cancers (Basel) 2023; 15:4365. [PMID: 37686642 PMCID: PMC10486905 DOI: 10.3390/cancers15174365] [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: 08/08/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Vestibular schwannoma (VS) are equally common in men and woman. A number of epidemiological studies have reported on sex-specific aspects of incidence, tumor size, tinnitus and hearing loss. However, data on sex-specific, pre- and post-surgically quality of life (QoL) are rare. The objective of the present study was to determine sex-specific aspects on QoL in VS. Health-related QoL was analyzed in 260 patients (112 male/148 female) with unilateral sporadic VS using general (SF-36: general Short-Form Health Survey), disease-specific (PANQOL: Penn Acoustic Neuroma Quality-of-Life Scale, PANQOL) and symptom-specific (DHI: Dizziness Handicap Inventory; HHI: Hearing Handicap Inventory; THI: Tinnitus Handicap Inventory; FDI: Facial Disability Index) QoL questionnaires. Sex differences were evaluated pre- and postoperative by multi- and univariate analyses based on 200 preoperative and 88 postoperative questionnaires. Female patients were significantly more affected by dizziness, headaches, reduced energy and anxiety. Energy and balance changed similarly in both sexes after surgery. However, postoperative women tended to be more affected by facial palsy and headaches than men. Despite the greater physical impairment, general health improved equivalently or even more in female patients than in males. In conclusion, self-rated QoL in VS is significantly affected by sex and surgery. This should be taken into account when counseling VS patients regarding observation, radiotherapy, and surgery.
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Affiliation(s)
- Kathrin Machetanz
- Department of Neurosurgery and Neurotechnology, Eberhard Karls University, 72074 Tuebingen, Germany
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Yang X, Man D, Yang Y, Li X. Feasibility of an endoscope-dominated side-to-end hypoglossal-facial anastomosis: an anatomical study. Front Surg 2023; 10:1251527. [PMID: 37671034 PMCID: PMC10475590 DOI: 10.3389/fsurg.2023.1251527] [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: 07/01/2023] [Accepted: 07/25/2023] [Indexed: 09/07/2023] Open
Abstract
Objective A surgical simulation of an endoscope-dominated side-to-end hypoglossal-facial anastomosis was performed to evaluate the feasibility. Methods Eight anatomical cadaver heads (16 sides) were recruited. The steps in conventional procedures were abbreviated or omitted. A facial nerve was first harvested near its external genu and was used for a side-to-end hypoglossal-facial anastomosis. The stump of the used facial nerve was truncated and recycled immediately caudal to the facial recess in another anastomosis and then recycled again at the stylomastoid foramen. As a recycled stump becomes too short to ensure a side-to-end anastomosis, the hypoglossal nerve was transected in situ, and an endoscopic end-to-end hypoglossal-facial anastomosis was attempted. Surgical simulation and quantitative measurement methods were used to analyze the anastomosis effects of different harvested sites of the facial nerve. Results Several steps in the conventional procedures provide little benefit in endoscopic surgery. A facial nerve stump recycled at the stylomastoid foramen is too short to ensure a tensionless side-to-end anastomosis. An endoscopic end-to-end hypoglossal-facial anastomosis was feasible, although it required more time than the classical microsurgical anastomosis. The greater agility of an endoscope enables the conventional surgical steps to be overlapped or interweaved into the procedure. Conclusions The multiple surgical fields and ability to manipulate the viewpoint provided by an endoscope have brought about breakthroughs in classical surgical paradigms. In addition, it is best to choose the sites of the facial nerve harvested near the external genu. If unavailable, an alternative section site could be selected immediately caudal to the facial recess, but cannot be distal to the stylomastoid foramen. The length of the stump should be individualized and preferably optimized with a nerve stimulator.
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Affiliation(s)
- Xiaobing Yang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Dulegeqi Man
- Department of Neurosurgery, International Mongolia Hospital of Inner Mongolia, Hohhot, China
| | - Yang Yang
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital, Cheeloo College of Medicine and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China
- Jinan Microecological Biomedicine Shandong Laboratory and Shandong Key Laboratory of Brain Function Remodeling, Jinan, China
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Kenton NR, Estafanous M, Itamura K, Filus A, Gowrinathan S, Martin NA, Sivakumar W, Barkhoudarian G, Byrne PJ, Kochhar A. Patient Perception of Education, Care Coordination, and Psychological Distress After Developing Facial Paralysis: A Qualitative Study. JAMA Otolaryngol Head Neck Surg 2023; 149:485-492. [PMID: 37079310 PMCID: PMC10119771 DOI: 10.1001/jamaoto.2023.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/11/2023] [Indexed: 04/21/2023]
Abstract
Importance The management of vestibular schwannoma may include observation, microsurgical resection, or radiation of a tumor near the facial nerve. Injury to the facial nerve can result in facial paralysis with major functional, social, and psychological sequelae, and the experiences of patients after paralysis are not well studied. Objective To (1) identify patient preparedness for developing facial paralysis and how well their care is coordinated following its development and (2) present in their own words outcomes of facial paralysis in terms of physical health, emotional health, self-perception, and social interactions. Design, Setting, and Participants A qualitative observational study was performed using semistructured interviews at a tertiary care academic medical center. Semistructured interviews were conducted between January 1, 2018, and June 30, 2019, with adults aged 25 to 70 years who developed facial paralysis after treatment for vestibular schwannoma. Data were analyzed from July 2019 to June 2020. Main Outcomes and Measures Perceptions of the educational and emotional experiences of individuals who developed complete facial paralysis after surgical treatment of vestibular schwannoma. Results Overall, 12 participants were interviewed (median age, 54 years [range, 25-70 years]; 11 were female). Saturation was achieved after 12 interviews, indicating that no further information could be elicited from additional interviews. Four major themes were identified: (1) lack of sufficient patient education about the diagnosis of facial paralysis; (2) lack of appropriate care coordination related to facial paralysis; (3) changes in physical and emotional health following facial paralysis; and (4) changes in social interactions and external support following facial paralysis. Conclusions and Relevance It is well-known that patients with facial paralysis have reduced quality of life, severe psychological and emotional sequelae. However, little is currently done to help prepare patients for this undesirable outcome. In this qualitative study of facial paralysis, patients express, in their own words, their feeling that the education and management of facial paralysis by their clinicians was inadequate. Before patients undergo surgery, and certainly after injury to the facial nerve, clinicians should consider the patient's goals, preferences, and values to ensure that a comprehensive educational program and psychosocial support system are implemented. Facial reanimation research has not adequately captured these key patient factors associated with the quality of communication.
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Affiliation(s)
- Natalie R. Kenton
- Center for Outcomes Research and Education, Providence St Joseph Health, Portland, Oregon
| | - Merai Estafanous
- Loma Linda University School of Medicine, Loma Linda, California
| | - Kyohei Itamura
- Cedars-Sinai Otolaryngology–Head and Neck Surgery, Beverly Hills, California
| | - Ania Filus
- University of Southern California, Los Angeles, California
| | - Shanthi Gowrinathan
- St John’s Cancer Institute, Pacific Neuroscience Institute, Providence St John’s Medical Center, Santa Monica, California
| | - Neil A. Martin
- St John’s Cancer Institute, Pacific Neuroscience Institute, Providence St John’s Medical Center, Santa Monica, California
| | - Walavan Sivakumar
- St John’s Cancer Institute, Pacific Neuroscience Institute, Providence St John’s Medical Center, Santa Monica, California
| | - Garni Barkhoudarian
- St John’s Cancer Institute, Pacific Neuroscience Institute, Providence St John’s Medical Center, Santa Monica, California
| | | | - Amit Kochhar
- St John’s Cancer Institute, Pacific Neuroscience Institute, Providence St John’s Medical Center, Santa Monica, California
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Vargo M, Ding P, Sacco M, Duggal R, Genther DJ, Ciolek PJ, Byrne PJ. The psychological and psychosocial effects of facial paralysis: A review. J Plast Reconstr Aesthet Surg 2023; 83:423-430. [PMID: 37311285 DOI: 10.1016/j.bjps.2023.05.027] [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: 04/16/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023]
Abstract
Facial nerve function is essential for a multitude of processes in the face, including facial movement; expression; and functions, such as eating, smiling, and blinking. When facial nerve function is disrupted, facial paralysis may occur and various complications for the patient may result. Much research has been conducted on the physical diagnosis, management, and treatment of facial paralysis. However, there is a lack of knowledge of the psychological and social effects of the condition. Patients may be at an increased risk for anxiety and depression, as well as negative self and social perceptions. This review analyzes the current literature on the various adverse psychological and psychosocial effects of facial paralysis, factors that may play a role, and treatment options that may help improve patients' quality of life.
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Affiliation(s)
- Mia Vargo
- Department of Cognitive Science, Case Western Reserve University, United States
| | - Peng Ding
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
| | - Matthew Sacco
- Center for Adult Behavioral Health, Cleveland Clinic, United States
| | - Radhika Duggal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, United States
| | - Dane J Genther
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Peter J Ciolek
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Patrick J Byrne
- Head and Neck Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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Wang MY, Jia CG, Xu HQ, Xu CS, Li X, Wei W, Chen JC. Development and Validation of a Deep Learning Predictive Model Combining Clinical and Radiomic Features for Short-Term Postoperative Facial Nerve Function in Acoustic Neuroma Patients. Curr Med Sci 2023; 43:336-343. [PMID: 37059936 PMCID: PMC10103675 DOI: 10.1007/s11596-023-2713-x] [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: 11/15/2022] [Accepted: 01/14/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE This study aims to construct and validate a predictable deep learning model associated with clinical data and multi-sequence magnetic resonance imaging (MRI) for short-term postoperative facial nerve function in patients with acoustic neuroma. METHODS A total of 110 patients with acoustic neuroma who underwent surgery through the retrosigmoid sinus approach were included. Clinical data and raw features from four MRI sequences (T1-weighted, T2-weighted, T1-weighted contrast enhancement, and T2-weighted-Flair images) were analyzed. Spearman correlation analysis along with least absolute shrinkage and selection operator regression were used to screen combined clinical and radiomic features. Nomogram, machine learning, and convolutional neural network (CNN) models were constructed to predict the prognosis of facial nerve function on the seventh day after surgery. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate model performance. A total of 1050 radiomic parameters were extracted, from which 13 radiomic and 3 clinical features were selected. RESULTS The CNN model performed best among all prediction models in the test set with an area under the curve (AUC) of 0.89 (95% CI, 0.84-0.91). CONCLUSION CNN modeling that combines clinical and multi-sequence MRI radiomic features provides excellent performance for predicting short-term facial nerve function after surgery in patients with acoustic neuroma. As such, CNN modeling may serve as a potential decision-making tool for neurosurgery.
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Affiliation(s)
- Meng-Yang Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Chen-Guang Jia
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Huan-Qing Xu
- School of Medical Information Engineering, Anhui University of Chinese Medicine, Hefei, 230012, China
| | - Cheng-Shi Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiang Li
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Wei Wei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Jin-Cao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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'Everybody is watching me': A closer look at anxiety in people with facial palsy. J Plast Reconstr Aesthet Surg 2023; 77:408-415. [PMID: 36638757 DOI: 10.1016/j.bjps.2022.11.019] [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: 06/07/2022] [Revised: 09/09/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Objectives were to evaluate the sociodemographic and disease-related factors, and coping style associated with social interaction and social appearance anxiety in people with unilateral facial palsy. METHODS Medical data were extracted from electronic health records, and participants completed the Social Interaction Anxiety Scale (SIAS), Social Appearance Anxiety Scale (SAAS), and Coping Orientation to Problems Experienced inventory. Associations of SIAS and SAAS scores with sociodemographic and disease variables, and coping were assessed with multiple linear regression. RESULTS Among 111 participants (mean age 58.6 years; 59% women), higher age and greater use of emotion-focused coping were associated with lower SIAS scores, whereas greater use of avoidant coping was associated with higher SIAS scores. Higher age, male sex, and greater use of emotion-focused coping were associated with lower SAAS scores, whereas greater use of avoidant coping was associated with higher SAAS scores. CONCLUSIONS Healthcare providers should understand that women and younger people are more likely to have social appearance concerns and that this is not predicted by the objective severity of facial palsy.
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The Average Facial Expressions: A Range of Motion Analysis for Different Sex and Age Groups. Plast Reconstr Surg Glob Open 2023; 11:e4762. [PMID: 36776597 PMCID: PMC9911205 DOI: 10.1097/gox.0000000000004762] [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: 08/12/2022] [Accepted: 11/15/2022] [Indexed: 02/04/2023]
Abstract
Facial expressions are ubiquitous in communication. Therefore, assessment of mimic function is essential in facial surgery, but no reference standards are currently available. This prospective study aims to create reference values of three-dimensional landmark displacement for different sex and age groups. Methods Three-dimensional photographs were taken from healthy subjects in rest, maximum closed smile, and pouting. Displacement for both exercises of perioral landmarks was analyzed with MATLAB as absolute displacement and as the ratio of mouth width. Additionally, displacement in three planes was analyzed for each landmark. Averages were calculated for both genders in four age groups: 4-8, 8-12, 12-16, and >16 years. Results In total, 328 subjects were included. Oral landmarks predominantly moved forward and backward for both exercises. Nasal landmarks predominantly moved vertically. Growing up, oral landmark displacement decreased for smiling, whereas nasal landmark displacement increased. For pouting, oral landmark displacement increased while growing up, whereas nasal landmark displacement decreased. Conclusions The present study creates reference values for movement of perioral structures for different sex and age groups, for two facial expressions. These data are of great value for the assessment of mimic function and give insight into the development of facial animation over time.
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Rist TM, Segars K, Oyer SL. Influence of Subclinical Anxiety and Depression on Quality of Life and Perception of Facial Paralysis. Facial Plast Surg Aesthet Med 2023; 25:27-31. [PMID: 35984930 DOI: 10.1089/fpsam.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Introduction: Patients with facial paralysis have increased psychosocial distress, which affects overall quality of life (QOL). Objective: To evaluate the relationship between QOL and paralysis severity among patients with subclinical anxiety and/or depression. Methods: Patients with facial paralysis were screened for anxiety and depression using the Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 surveys. QOL scores (Facial Clinimetric Evaluation) and paralysis severity scores (House-Brackmann [HB] and Sunnybrook [SB]) were collected. Patients with a mental health diagnosis or treatment were excluded. Univariate and multivariate analyses and Pearson's correlations were performed after stratifying by anxiety and/or depression screenings. Results: Positive anxiety and depression screening rates were 25.78% and 22.66%, respectively. Patients screening positive had significantly worse QOL scores despite no difference in paralysis severity. QOL scores did not correlate with SB scores among patients who screened positive for depression. Conclusion: Patients screening positive for anxiety and/or depression demonstrated worse QOL, which did not correlate with paralysis severity suggesting that health care professionals should remain alert to mental health symptoms when QOL impairment is out of proportion with the severity of paralysis.
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Affiliation(s)
- Tyler M Rist
- Department of Otolaryngology Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelly Segars
- Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Samuel L Oyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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14
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Trends in Facial Paralysis Management: A National Survey Study. J Craniofac Surg 2022; 33:1754-1761. [PMID: 35949018 DOI: 10.1097/scs.0000000000008725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Advances in operative management, minimally invasive procedures, and physical therapy have allowed for dramatic improvements in functional and cosmetic outcomes in patients with facial paralysis. Our goal was to evaluate the current trends and practice patterns in the diagnosis and management of facial paralysis by provider demographics. MATERIALS AND METHODS An electronic questionnaire was distributed to members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Practice patterns in the diagnosis and treatment were compared by level of training (fellowship-trained facial plastic and reconstructive surgeon versus non-fellowship trained), practice type (academic and private), practice length, patient volume, and presence of a dedicated facial nerve clinic. The bivariate associations of the outcome variables and the stratification factors were analyzed using 2-way contingency tables and Fisher's exact tests. RESULTS The survey was sent to 1129 members of the AAFPRS. The response rate was 11.7% (n=132). Most respondents were fellowship-trained surgeons (79%) in the academic setting (55%), and most have been in practice for more than 10 years (53%). Practice setting and patient volume were the factors most associated with significant variations in management, including the use of facial paralysis grading scales, photography/videography, patient-reported outcome metrics, as well as differences in both noninvasive and surgical management. CONCLUSION Based on the present study, several physician demographic factors may play a role in choosing which diagnostic and treatment options are employed for facial paralysis, with practice setting and patient volume appearing to be the 2 variables associated with the most significant differences.
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Marston AP, Ziegler JP, Oyer SL. Masseteric-to-facial nerve transfer for treatment of pediatric facial paralysis: An initial report. Int J Pediatr Otorhinolaryngol 2022; 157:111134. [PMID: 35427997 DOI: 10.1016/j.ijporl.2022.111134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/01/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The indications and outcomes of masseteric-to-facial nerve transfer in pediatric patients with short-term facial paralysis is incompletely understood as compared to its use in adult patients. This report aims to retrospectively quantify outcomes with both clinician-based measurements and objective facial analysis software. METHODS Retrospective case series at a single institution. The Sunnybrook Facial Grading System was used for clinician-based measurements and Emotrics software for objective measurements. RESULTS Four pediatric patients underwent masseteric-to-facial nerve transfers from 2016 to 2018. The mean patient age at the time of surgery was 4.5 years (range = 2-7) and the mean time from paralysis onset to surgical intervention was 12.9 months (range = 10.0-16.2). The mean follow-up was 18.3 months (range = 14.5-23.6). With regards to the Sunnybrook resting nasolabial fold symmetry, 3 of the 4 patients improved from 2 (absent nasolabial fold) to 1 (less pronounced nasolabial fold). Per the Emotrics analysis, the pre- and post-operative mean absolute differences for commissure excursion between the normal functioning and paralyzed sides were 11.8 mm and 6.7 mm, respectively (p = 0.04). CONCLUSION The masseteric-to-facial nerve transfer technique leads to an objective improvement in dynamic smile function in select pediatric patients.
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Affiliation(s)
- Alexander P Marston
- Department of Otolaryngology - Head and Neck Surgery, Tufts University School of Medicine, 800 Washington St., Boston, MA, 02111, USA.
| | - John P Ziegler
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave., MSC 550, Charleston, SC, 29425, USA.
| | - Samuel L Oyer
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health, PO Box 800713, Charlottesville, VA, 22908, USA.
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16
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Evaluating the effectiveness and acceptability of information and therapy guides for improving the psychosocial well-being of people with facial palsy. J Plast Reconstr Aesthet Surg 2022; 75:3356-3364. [PMID: 35623976 DOI: 10.1016/j.bjps.2022.04.022] [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: 12/15/2021] [Accepted: 04/12/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Facial palsy (FP) can have a negative impact on an individual's psychological and social well-being, irrespective of esthetic severity. There is a lack of psychological interventions tailored specifically for this population and individuals with FP report difficulties accessing specialist psychological treatment. This paper describes a pilot study evaluating the effectiveness, acceptability, and feasibility of information and therapy guides for this population. DESIGN Quasi-experimental, repeated measures design. METHODS Six separate information and therapy guides were designed, drawing on cognitive behavioral therapy, acceptance and commitment therapy, and social skills training approaches. These were tested by 132 participants with FP, over a 4-to-6-week period. Participants completed self-report measures assessing psychological well-being, social function, and appearance-related distress before and after the testing period, as well as provided feedback on the perceived effectiveness, acceptability, and feasibility of the intervention. RESULTS After completing an information and therapy guide, participants reported significant improvements in psychological well-being and social function, as well as improvements in appearance-related distress. Ninety percent of participants reported having found it helpful to complete a guide, while 79.7% reported feeling more able to cope with FP and 95.3% agreed that the guide had been easy to understand and use. CONCLUSIONS Self-guided information and therapy guides are an acceptable and effective intervention for improving the psychosocial well-being of people with FP. They provide a low-intensity, universal, and cost-effective option for supporting the psychological needs of this population. CLINICAL TRIAL REGISTRATION NUMBER NCT03943953.
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Treatment for vestibular schwannoma: Systematic review and single arm meta-analysis. Am J Otolaryngol 2022; 43:103337. [PMID: 34973662 DOI: 10.1016/j.amjoto.2021.103337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 11/13/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Vestibular schwannoma is a benign tumor in the schwannoma cells of the 8th cranial nerve. It causes symptoms like tinnitus, vertigo and end up with loss of hearing so the appropriate treatment is very important. There are many treatment techniques including conservative, surgery and radiosurgery. We aimed to systematically review and single arm meta-analysis the different treatment techniques of vestibular schwannoma. METHODS A comprehensive literature search using thirteen databases including PubMed, Scopus, and Web of Science was performed. All clinical trials about treatment vestibular schwannoma were included and single arm meta-analyzed. We assessed the risk of bias using ROBIN-I's tool and scale of Council Australia's Cancer Guidelines Wiki. The protocol was registered in PROSPERO (CRD42018089784) and has been updated on 17 April 2019. RESULTS A total of 35 clinical trials studies were included in the final analysis. The pooled proportion of stable hearing capability in patients receiving gamma knife radiosurgery (GKRS) was 64% (95% CI: 52%-74%). GKRS favored increased hearing capability 10% (95% CI: 7%-16%). Regarding tumor size, GKRS is the most protective method 53% (95% CI: 37%-69%). Complications occurred most commonly in single fractional linac stereotactic radiosurgery (SFSRT) 37% (95% CI: 12%-72%). CONCLUSION Our analysis suggested gamma knife radiosurgery could be the most ideal treatment for vestibular schwannoma based on stabilizing hearing capability, increasing hearing capability, decreasing tumor size and complications.
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18
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Bender M, Tatagiba M, Gharabaghi A. Quality of Life After Vestibular Schwannoma Surgery: A Question of Perspective. Front Oncol 2022; 11:770789. [PMID: 35223451 PMCID: PMC8873590 DOI: 10.3389/fonc.2021.770789] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveHealth-related quality of life (HRQoL) and self-reported outcome measures have a relevant impact on the medical decision-making process. They capture either the current status and allow for multiple prospective evaluations in the course of a treatment or rely on the retrospective comparison of health of patients before and after an intervention to assess its benefit. Importantly, these patient-assessed measures may be influenced by psychological factors. We compared HRQoL and perceived benefit in the course of surgical vestibular schwannoma (VS) treatment, as assessed by the patients from a prospective and retrospective point-of-view, and evaluated the influence of co-morbid depression.MethodsWithin a prospective observational single-center study, forty-three patients with VS were investigated before and after retrosigmoid tumor resection. SF-36, Beck Depression Inventory and patient-assessed clinical symptoms were acquired before surgery and at follow-up. At follow-up, the Glasgow Benefit Inventory (GBI) was acquired as well.ResultsSF-36 scores were significantly lower than the age and sex matched normative data in six and three out of eight categories before and after surgery, respectively. Three categories improved significantly after vs. before surgery; one of them (global health) reached a minimal clinical important difference. In contrast, patients reported predominantly a deterioration, when asked for a retrospective evaluation of the benefit (i.e., GBI). Depression correlated with both SF-36 and GBI, determined dissatisfaction, improved significantly after surgery and was the measure that had the largest impact on HRQoL.ConclusionProspective and retrospective HRQoL measures may lead to different findings and can be confounded by psychological factors.
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Siemann I, Sanches EE, de Jongh FW, Luijmes R, Ingels KJAO, Beurskens CHG, Monstrey SJ, Ramnarain D, Marres HAM, Pouwels S. Psychological counselling in patients with a peripheral facial palsy: initial experience from an expert centre. J Plast Reconstr Aesthet Surg 2021; 75:1639-1643. [PMID: 34975004 DOI: 10.1016/j.bjps.2021.11.079] [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: 09/08/2020] [Revised: 07/13/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aims of this pilot study were to evaluate the psychologist's role on the multidisciplinary team during peripheral facial palsy (PFP) patient care and to identify the potential predictors of anxiety and depressive symptoms/disorders in PFP patients. METHODS Using the prospective non-controlled study design, PFP patients aged 18-75 years who presented to the Radboud Facial Palsy Expert Centre, the Netherlands, were enrolled during a 1-year interval. The main outcome variables were 1) anxiety and depression in relation to PFP using the Hospital Anxiety and Depression Scale (HADS) and 2) the outcome of psychological counselling in patients with a HADS score ≥ 8. RESULTS A sample comprised 25 patients (68% females, 56% right-side PFP, 16% House-Brackmann scale I-II) with a mean age of 50 ± 14 years were referred to a psychologist. The proportion of patients with a HADS score ≥8, were 16 (64%) and 13 (52%), respectively. Especially, coping (in general or coping with the disease, 48%) and/or help with the choice of possible surgery (8.0%) were important reasons for counselling. In one case, a patient had chronic fatigue syndrome and was therefore referred to a psychological specialist centre. One patient was treated with acceptance and commitment therapy (ACT) with good results. CONCLUSIONS Despite a small sample size and limited statistical analyses, the results of this study suggest that one-eighth of the PFP patients require psychological evaluation and treatments. This pilot study emphasises the important role of psychological screening and counselling in PFP patient care.
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Affiliation(s)
- Ietske Siemann
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - Elijah E Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Frank W de Jongh
- Department of Plastic Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Robin Luijmes
- Department of Interventions, Arbo Unie, Rotterdam Europoort, Rotterdam, The Netherlands
| | - Koen J A O Ingels
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Carien H G Beurskens
- Department of Orthopedics, section Physical Therapy, Radboudumc, Nijmegen, The Netherlands
| | - Stan J Monstrey
- Department of Plastic Surgery, University Hospital Gent, Gent, Belgium
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head & Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
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Hobson CE, Saliba J, Vorasubin N, Lyles RH, Mastrodimos B, Cueva RA. Vestibular Schwannoma Cerebellopontine Angle Position Impacts Facial Outcome. Laryngoscope 2021; 132:1093-1098. [PMID: 34704617 DOI: 10.1002/lary.29922] [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: 04/01/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the impact of vestibular schwannoma (VS) position relative to the internal auditory canal (IAC) on postoperative facial nerve function and extent of surgical resection. STUDY DESIGN Retrospective chart review. METHODS Retrospective review of patients undergoing resection of large (≥25 mm) VSs. Outcome measures included early (≤1 month) facial function, long-term (≥1 year) facial function and extent of resection. Tumor measurements included the greatest dimension, dimension anterior to the IAC axis, dimension posterior to the IAC axis, and a ratio of posterior-to-anterior dimension (PA ratio). RESULTS A total of 127 patients met inclusion criteria. In early follow-up, 60% patients had good (House-Brackmann I-II), and 40% patients had poor (House-Brackmann III-VI) facial function. In long-term follow-up, 71% patients had good, and 29% patients had poor facial function. A total of 72% of patients underwent gross total resection (GTR) of their tumors. Patients with good facial function had significantly larger PA ratios than patients with poor function both early and long term; however, greatest dimension was the more clearly significant independent predictor of facial outcomes. A larger PA ratio was observed in patients in whom GTR was achieved, but this association was potentially confounded by surgeon preferences and was not statistically significant after controlling for surgical site. CONCLUSIONS This study demonstrates that VS position relative to the IAC axis can be used along with tumor size to predict postoperative facial outcomes. A greater proportion of tumor posterior to the IAC axis was associated with significantly better facial outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Candace E Hobson
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Southern California Permanente Medical Group, San Diego, California, U.S.A
| | - Joe Saliba
- Department of Otolaryngology-Head and Neck Surgery, Southern California Permanente Medical Group, San Diego, California, U.S.A.,Division of Otolaryngology-Head and Neck Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Nopawan Vorasubin
- Department of Otolaryngology-Head and Neck Surgery, Southern California Permanente Medical Group, San Diego, California, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Southern California Permanente Medical Group, Los Angeles, California, U.S.A
| | - Robert H Lyles
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, U.S.A
| | - Bill Mastrodimos
- Department of Neurosurgery, Southern California Kaiser Permanente Medical Group, San Diego, California, U.S.A
| | - Roberto A Cueva
- Department of Otolaryngology-Head and Neck Surgery, Southern California Permanente Medical Group, San Diego, California, U.S.A
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21
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Volk GF, Hesse S, Geißler K, Kuttenreich AM, Thielker J, Dobel C, Guntinas-Lichius O. Role of Body Dysmorphic Disorder in Patients With Postparalytic Facial Synkinesis. Laryngoscope 2021; 131:E2518-E2524. [PMID: 33729598 DOI: 10.1002/lary.29526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the role of body dysmorphic disorder (BDD) in patients with postparalytic facial nerve syndrome with synkinesis (PFS). STUDY DESIGN A single-center retrospective cohort study. METHODS A total of 221 adults (74% women; median age: 44 years; median duration since onset of facial palsy: 1.6 years) were included. To diagnose BDD, the BDD Munich Module was used. Associations with House-Brackmann grading, Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, Facial Disability Index (FDI), general quality of life (SF-36), Beck Depression Inventory (BDI), and the Liebowitz Social Anxiety Scale (LSAS) was analyzed. RESULTS A total of 59 patients (27%) were classified as patients with BDD. Significant associations were found between the diagnosis of BDD and female gender and lower FDI, FaCE, and SF-36 scores and higher BDI and LSAS scores. Multivariate analysis revealed BDI, FaCE total score, and FaCE social function subscore as independent factors associated with BDD. CONCLUSION BDD was a relevant diagnosis in patients with PFS. A higher BDD level was associated with general and facial-specific quality of life and more psychosocial disabilities. Optimal treatment of PFS has to include these nonmotor dysfunctions. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2518-E2524, 2021.
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Affiliation(s)
- Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Susanne Hesse
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Anna-Maria Kuttenreich
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Christian Dobel
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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22
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Hamlet C, Williamson H, Hotton M, Rumsey N. 'Your face freezes and so does your life': A qualitative exploration of adults' psychosocial experiences of living with acquired facial palsy. Br J Health Psychol 2021; 26:977-994. [PMID: 33611831 DOI: 10.1111/bjhp.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/22/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Facial palsy (FP) is a highly visible appearance-affecting condition and can have a significant impact on facial function. Qualitative research focussing on adults' experiences of living with acquired FP is limited. This study aimed to explore the psychosocial impact of acquired FP and to gain a greater understanding of patients' experiences of treatment and care in the United Kingdom. DESIGN A qualitative interview study with individuals living with acquired FP. METHODS Ten adults with acquired FP were recruited. Their experiences were explored using semi-structured telephone interviews. Data were analysed using thematic analysis. RESULTS Five master themes were identified through the thematic analysis: 1) grappling with a new identity, 2) the psychosocial impact of living with facial palsy, 3) isolation: dealing with 'one hell of a problem on your own', 4) a life on hold, 5) coping strategies. Findings indicated high levels of distress and significant challenges in managing the functional and psychosocial changes associated with acquiring FP. Participants expressed grief for their former appearance and identity, with photographs and mirrors acting as agonizing reminders. Many reported a sense of abandonment due to uncoordinated care and, as a result, engaged in an endless and often fruitless pursuit to gain control over FP by experimenting with their own treatment. Many reported the negative impact of their altered facial expressions on social interactions and a fear of being negatively evaluated. CONCLUSIONS This study highlights a pressing need to review how FP is managed in the UK. To improve patient well-being, health care professionals could benefit from FP education, and patients from timely access to psychological support and clearer standards of care following diagnosis.
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Affiliation(s)
- Claire Hamlet
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Matthew Hotton
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
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23
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Shtraks JP, Mirocha J, Azizzadeh B. Quality of Life Outcomes After Modified Selective Neurectomy for Postfacial Paralysis Synkinesis. Facial Plast Surg Aesthet Med 2021; 23:443-448. [PMID: 33605776 DOI: 10.1089/fpsam.2020.0485] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Until now, quality of life (QOL) outcomes after modified selective neurectomy for postfacial paralysis synkinesis (PFPS) have not been assessed. Objective: To evaluate QOL outcomes among patients with PFPS who underwent modified selective neurectomy. Methods: The medical records of patients aged ≥18 years with PFPS who underwent modified selective neurectomy during a 6-year period were reviewed. QOL outcomes were measured using the Facial Clinimetric Evaluation (FaCE) scale and Synkinesis Assessment Questionnaire (SAQ). Results: At <1 year after selective neurectomy, there was improvement in mean SAQ (from 26.6 [95% confidence interval {CI}, 23.7-29.5] to 21.4 [95% CI, 19.5-23.3]; p < 0.0001). Mean FaCE scores improved (from 47.1 [95% CI, 43.6-50.6] to 62.6 [95% CI, 58.7-66.5]; p < 0.0001), with improvements in all subscores except lacrimal control scores (from 61.7 [95% CI, 52.6-70.9] to 62.2 [95% CI, 53.6-70.9]; p = 0.91). At >1 year after surgery, there was improvement in mean SAQ score (from 28.8 [95% CI, 26.0-31.6] to 23.4 [95% CI, 21.0-25.7]; p < 0.0001). Mean FaCE scores improved (from 45.9 [95% CI, 41.6-50.3] to 59.4 [95% CI, 53.6-65.2]; p < 0.0001), with improvements in all subscores except eye comfort and lacrimal control (from 52.4 [95% CI, -40.8-64.0] to 56.8 [95% CI, 45.5-68.0]; p = 0.36), and lacrimal control scores worsened (from 68.0 [95% CI, 56.7-79.2] to 56.3 [95% CI, 44.8-67.7]; p = 0.023). Conclusions: Modified selective neurectomy results in QOL improvements in patients with PFPS.
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Affiliation(s)
- Julie P Shtraks
- Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA
| | - James Mirocha
- Biostatistics Core, Research Institute and General Clinical Research Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Babak Azizzadeh
- Center for Advanced Facial Plastic Surgery, Beverly Hills, California, USA
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24
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Pattinson R, Poole HM, Shorthouse O, Sadiq SA, Bundy C. Exploring beliefs and distress in patients with facial palsies. PSYCHOL HEALTH MED 2021; 27:788-802. [PMID: 33486991 DOI: 10.1080/13548506.2021.1876891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence suggests that people with facial palsy may experience higher levels of distress, but the reasons for this are yet to be explored. This study aimed to explore people's illness beliefs, emotions, and behaviours in relation to their facial palsy and understand how distress is experienced by this group. Semi-structured individual interviews were conducted in the UK with adults with facial palsy. Interview questions were theoretically informed by the Common-Sense Self-Regulatory Model (CS-SRM). Thematic Analysis was conducted following a combined inductive and deductive approach. Twenty people with facial palsy participated (70% female; aged 29-84). Patient distress was accounted for by illness beliefs (symptoms, cause, control and treatment, timeline and consequences), and four additional themes (coping behaviours, social support, identity and health service provision). Experiences of anxiety, depression, and anger were widespread, and some participants experienced suicidal ideation. The burden of managing a long-term condition, altered self-perception, and social anxiety and isolation were key drivers of distress. There is a need for more integrated psychological support for patients with facial palsy. Within clinical consultations, patient's beliefs about facial palsy should be identified and systematically addressed. Service development should include appropriate referral to specialist psychological support via an established care pathway.
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Affiliation(s)
- R Pattinson
- School of Healthcare Sciences, College of Biomedical Sciences, Cardiff University, Cardiff, UK
| | - H M Poole
- School of Psychology, Liverpool John Moores University, Liverpool John Moores University, Liverpool, UK
| | - O Shorthouse
- Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - S A Sadiq
- Manchester Royal Eye Hospital, Manchester, UK
| | - C Bundy
- School of Healthcare Sciences, College of Biomedical Sciences, Cardiff University, Cardiff, UK
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Bruins TE, van Veen MM, Mooibroek-Leeuwerke T, Werker PMN, Broekstra DC, Dijkstra PU. Association of Socioeconomic, Personality, and Mental Health Factors With Health-Related Quality of Life in Patients With Facial Palsy. JAMA Otolaryngol Head Neck Surg 2021; 146:331-337. [PMID: 32053138 DOI: 10.1001/jamaoto.2019.4559] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Knowledge of factors associated with health-related quality of life in patients with facial palsy may aid in better interpreting outcomes of research and treatment. Objective To identify factors associated with health-related quality of life in patients with facial palsy. Design, Setting, and Participants The inclusion period for participants in this cross-sectional study at the University Medical Center Groningen, a tertiary referral center for facial reanimation surgery, was March 1 to June 1, 2019. Patients aged at least 18 years with facial palsy who had undergone surgery for facial palsy between January 1, 2007, and January 1, 2018, and patients visiting the outpatient clinic of the University of Groningen Department of Plastic Surgery for their facial palsy between March 1 and June 1, 2019, were also asked to participate. Of 276 patients invited, 145 gave informed consent. Twenty patients did not respond after consent, 3 patients withdrew from the study, and 1 patient was wrongly included. Main Outcomes and Measures Health-related quality of life was measured using the Facial Clinimetric Evaluation Scale and the Facial Disability Index (physical score and social score). Facial function was assessed with the Sunnybrook Facial Grading System. Other variables were investigated using validated questionnaires, including the Duke University Religion Index, Ten-Item Personality Inventory, and Hospital Anxiety and Depression Scale. Multivariable linear regression analyses with stepwise backward selection were performed to identify associations with health-related quality of life. Because 44 Sunnybrook composite scores were missing, a sensitivity analysis was performed that excluded the Sunnybrook composite scores from the multivariable analysis. Results In total, 121 patients with facial palsy were included; their median age was 62 years (interquartile range, 48-71 years), and 63 (52%) were women. Sunnybrook composite score (β = 0.4; 95% CI, 0.2-0.5), extraversion (β = 2.6; 95% CI, 0.4-4.8), and anxiety (β = -2.4; 95% CI, -4.1 to -0.8) were associated with the Facial Clinimetric Evaluation Scale total score (R2 = 0.380; 95% CI, 0.212-0.548). The Sunnybrook composite score was associated with the Facial Disability Index physical score (β = 0.2; 95% CI, 0.0-0.4) (R2 = 0.084; 95% CI, -0.037 to 0.205). Bilateral facial palsy (β = -21.2; 95% CI, -32.3 to -10.1), extraversion (β = 2.7; 95% CI, 1.3-4.1), conscientiousness (β = 2.7; 95% CI, 0.2-5.2), emotional stability (β = 3.3; 95% CI, 1.7-4.8), and depression (β = -1.3; 95% CI, -2.5 to -0.1) were associated with the Facial Disability Index social score (R2 = 0.400; 95% CI, 0.262-0.538). In the sensitivity analysis, the Sunnybrook composite score was associated with age (Spearman ρ = -0.252). Conclusions and Relevance Bilateral facial palsy, age, severity of facial palsy, mental distress, and personality traits should be taken into account in future research and treatment of patients with facial palsy.
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Affiliation(s)
- Tessa E Bruins
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martinus M van Veen
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tanja Mooibroek-Leeuwerke
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M N Werker
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dieuwke C Broekstra
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pieter U Dijkstra
- Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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26
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Cuenca-Martínez F, Zapardiel-Sánchez E, Carrasco-González E, La Touche R, Suso-Martí L. Assessing anxiety, depression and quality of life in patients with peripheral facial palsy: a systematic review. PeerJ 2020; 8:e10449. [PMID: 33344085 PMCID: PMC7718791 DOI: 10.7717/peerj.10449] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Peripheral facial palsy (PFP) is predominantly a unilateral disorder of the facial nerve, which can lead to psychological disorders that can result in decreased quality of life. The aim of this systematic review was to assess anxiety, depression and quality of life symptoms associated with PFP. Data sources We searched the Medline, PEDro, CINAHL and Google Scholar databases to conduct this systematic review while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. The search was performed by two independent reviewers, and differences between the two reviewers were resolved by consensus. Study Selection The search terms used were derived from the combination of the following MeSH terms: "facial paralysis", "bell palsy", "anxiety", "anxiety disorders", "depression", "depressive disorders", "quality of life" and not MeSH: "facial palsy", "hemifacial paralysis", "facial paresis", "Peripheral Facial Paralysis", using the combination of different Boolean operators (AND/OR). Data Extraction On November 1st (2019). Data Synthesis In total, 18 cross-sectional articles and two case-control studies were selected. Conclusions The cross-sectional articles showed low methodological quality, while the case-control studies showed acceptable methodological quality. Limited evidence suggests that patients with PFP might have increased levels of anxiety and depressive symptoms. A qualitative analysis also showed limited evidence that quality of life might be diminished in patients with PFP. PROSPERO CRD42020159843.
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Affiliation(s)
- Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Eva Zapardiel-Sánchez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Carrasco-González
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Departament of Physiotherapy, Universidad CEU Cardenal Herrera, CEU Universities, Valencia, Spain
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Hedgehog signaling promotes endoneurial fibroblast migration and Vegf-A expression following facial nerve injury. Brain Res 2020; 1751:147204. [PMID: 33189691 DOI: 10.1016/j.brainres.2020.147204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Peripheral nerve injuries are a common clinical problem which may result in permanent loss of motor or sensory function. A better understanding of the signaling pathways that lead to successful nerve regeneration may help in discovering new therapeutic targets. The Hedgehog (Hh) signaling pathway plays significant roles in nerve development and regeneration. In a mouse model of facial nerve injury, Hedgehog-responsive fibroblasts increase in number both at the site of injury and within the distal nerve. However, the role of these cells in facial nerve regeneration is not fully understood. We hypothesize that the Hh pathway plays an angiogenic and pro-migratory role following facial nerve injury. METHODS Hedgehog pathway modulators were applied to murine endoneurial fibroblasts isolated from the murine facial nerve. The impact of pathway modulation on endoneurial fibroblast migration and cell proliferation was assessed. Gene expression changes of known Hedgehog target genes and the key angiogenic factor Vegf-A were determined by qPCR. In vivo, mice were treated with pathway agonist (SAG21k) and injured facial nerve specimens were analyzed via immunofluorescence and in situ hybridization. RESULTS Hedgehog pathway activation in facial nerve fibroblasts via SAG21k treatment increases Gli1 and Ptch1 expression, the rate of cellular migration, and Vegf-A expression in vitro. In vivo, expression of Gli1 and Vegf-A expression appears to increase after injury, particularly at the site of nerve injury and the distal nerve, as detected by immunofluorescence and in situ hybridization. Additionally, Gli1 transcripts co-localize with Vegf-A following transection injury to the facial nerve. DISCUSSION These findings describe an angiogenic and pro-migratory role for the Hedgehog pathway mediated through effects on nerve fibroblasts. Given the critical role of Vegf-A in nerve regeneration, modulation of this pathway may represent a potential therapeutic target to improve facial nerve regeneration following injury.
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Surgical management for large vestibular schwannomas: a systematic review, meta-analysis, and consensus statement on behalf of the EANS skull base section. Acta Neurochir (Wien) 2020; 162:2595-2617. [PMID: 32728903 PMCID: PMC7550309 DOI: 10.1007/s00701-020-04491-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The optimal management of large vestibular schwannomas continues to be debated. We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of this problem from a European perspective. MATERIAL AND METHODS A systematic review of MEDLINE database, in compliance with the PRISMA guidelines, was performed. A subgroup analysis screening all surgical series published within the last 20 years (January 2000 to March 2020) was performed. Weighted summary rates for tumor resection, oncological control, and facial nerve preservation were determined using meta-analysis models. This data along with contemporary practice patterns were discussed within the task force to generate consensual recommendations regarding preoperative evaluations, optimal surgical strategy, and follow-up management. RESULTS Tumor classification grades should be systematically used in the perioperative management of patients, with large vestibular schwannomas (VS) defined as > 30 mm in the largest extrameatal diameter. Grading scales for pre- and postoperative hearing (AAO-HNS or GR) and facial nerve function (HB) are to be used for reporting functional outcome. There is a lack of consensus to support the superiority of any surgical strategy with respect to extent of resection and use of adjuvant radiosurgery. Intraoperative neuromonitoring needs to be routinely used to preserve neural function. Recommendations for postoperative clinico-radiological evaluations have been elucidated based on the surgical strategy employed. CONCLUSION The main goal of management of large vestibular schwannomas should focus on maintaining/improving quality of life (QoL), making every attempt at facial/cochlear nerve functional preservation while ensuring optimal oncological control, thereby allowing to meet patient expectations. Despite the fact that this analysis yielded only a few Class B evidences and mostly expert opinions, it will guide practitioners to manage these patients and form the basis for future clinical trials.
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Ng IB, Heller RS, Heilman CB, Wu JK. Facial nerve outcomes following gamma knife radiosurgery for subtotally resected vestibular schwannomas: Early versus delayed timing of therapy. Clin Neurol Neurosurg 2020; 198:106148. [PMID: 32823189 DOI: 10.1016/j.clineuro.2020.106148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 08/09/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Initially treating vestibular schwannomas (VSs) with subtotal resection (STR) followed by Gamma Knife radiosurgery (GKRS) for progression of tumor residual is a strategy that balances maximal tumor resection with preservation of neurological function. The effect of timing of GKRS for residual and recurrent VSs remains poorly defined. We developed a simple and practical treatment algorithm for the timing of GKRS after STR of VSs and reviewed our follow-up results to determine outcomes between patients treated with early vs. late GKRS. PATIENTS AND METHODS Patients that underwent STR between 1999 and 2017 for a VS at Tufts Medical Center were identified and included in the study cohort. Patients who received GKRS ≤ 12 months after STR were included in the early intervention group. Patients who received GKRS > 12 months after STR or did not have tumor progression on follow-up thus not requiring GKRS were included in the observation/delayed intervention group. RESULTS STR of VSs was performed on 23 patients. Mean patient age at the time of STR was 53.0 years (range: 20-86.2). The mean follow-up was 4.2 years (range: 1 month-15.5 years). Patients most frequently presented with hearing loss. There were 5 patients (21.7 %) in the early intervention group and 18 (78.3 %) patients in the observation/delayed intervention group. Ten of 23 patients (43.5 %) required GKRS. Thirteen (56.5 %) did not receive GKRS. None of the patients in the early intervention group or the observation/delayed intervention group had changes in House-Brackmann (HB) Grade either after GKRS or at the end of the study period. CONCLUSIONS GKRS of residual or recurrent tumor is safe following STR of VS and appears to carry a low risk of worsening facial nerve function when performed for progressive tumor growth.
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Affiliation(s)
- Isaac B Ng
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Robert S Heller
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Carl B Heilman
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Julian K Wu
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA.
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Blom SSAH, Aarts H, Kunst HPM, Wever CC, Semin GR. Lateralization of facial emotion processing and facial paresis in Vestibular Schwannoma patients. Brain Behav 2020; 10:e01644. [PMID: 32396279 PMCID: PMC7375079 DOI: 10.1002/brb3.1644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study investigates whether there exist differences in lateralization of facial emotion processing in patients suffering from Vestibular Schwannoma (VS) based on the presence of a facial paresis and their degree of facial functioning as measured by the House Brackmann Grading scale (HBG). METHODS Forty-four VS patients, half of them with a facial paresis and half of them without a facial paresis, rated how emotive they considered images of faces showing emotion in the left versus right visual field. Stimuli consisted of faces with a neutral half and an emotional (happy or angry) half. The study had a mixed design with emotional expression (happy vs. angry) and emotional half (left vs. right visual field) of the faces as repeated measures, and facial paresis (present vs. absent) and HBG as between subjects' factors. The visual field bias was the main dependent variable. RESULTS In line with typical findings in the normal population, a left visual field bias showed in the current sample: patients judged emotional expressions shown in the left visual field as more emotive than those shown in the right visual field. No differences in visual field bias showed based on the presence of a facial paresis nor based on patients' HBG. CONCLUSION VS patients show a left visual field bias when processing facial emotion. No differences in lateralization showed based on the presence of a facial paresis or on patients' HBG. Based on this study, facial paresis thus does not affect the lateralization of facial emotion processing in patients with VS.
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Affiliation(s)
| | - Henk Aarts
- Department of PsychologyUtrecht UniversityUtrechtThe Netherlands
| | - Henricus P. M. Kunst
- Department of OtolaryngologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
- Department of OtolaryngologyMaastricht UMC+MaastrichtThe Netherlands
| | - Capi C. Wever
- Department of Otolaryngology – Head & Neck SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Gün R. Semin
- Department of PsychologyUtrecht UniversityUtrechtThe Netherlands
- William James Center for ResearchISPA – Instituto UniversitárioLisboaPortugal
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Hotton M, Huggons E, Hamlet C, Shore D, Johnson D, Norris JH, Kilcoyne S, Dalton L. The psychosocial impact of facial palsy: A systematic review. Br J Health Psychol 2020; 25:695-727. [PMID: 32538540 DOI: 10.1111/bjhp.12440] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/11/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Facial palsy is a condition which can lead to significant changes in facial function and appearance. People with facial palsy often report psychosocial difficulties, including withdrawal from social activities, anxiety, negative body image, and low mood. This paper aimed to review all published research investigating the psychosocial impact of facial palsy on adults. METHODS A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, and AMED databases was performed. The quality of included studies was assessed, and data were extracted with regard to characteristics of participants; study methodology and design; outcome measures used; and psychosocial outcomes. RESULTS Twenty-seven studies met inclusion criteria. A high proportion of people with facial palsy reported clinically significant levels of anxiety and depression, with greater difficulties typically reported by females, compared to males. Other difficulties consistently reported include low quality of life, poor social function, and high levels of appearance-related distress. Objective severity of facial palsy was consistently shown to not be associated with anxiety or depression, with psychological factors instead likely mediating the relationship between the severity of facial palsy and psychosocial well-being. CONCLUSIONS Irrespective of objective symptom severity, facial palsy has the potential to have a significant impact on psychosocial well-being and quality of life. The various methodological limitations of the included studies are discussed, along with clinical implications, including the need for greater access to psychological screening and interventions for people with facial palsy.
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Affiliation(s)
- Matthew Hotton
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Esme Huggons
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Claire Hamlet
- Centre for Appearance Research, University of the West of England, UK
| | - Danielle Shore
- Department of Experimental Psychology, University of Oxford, UK
| | - David Johnson
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jonathan H Norris
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Sarah Kilcoyne
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Louise Dalton
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
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Blom SSAH, Aarts H, Wever CC, Kunst HPM, Semin GR. Quality of life, social function, emotion, and facial paresis in Dutch vestibular schwannoma patients. Laryngoscope Investig Otolaryngol 2020; 5:477-484. [PMID: 32596491 PMCID: PMC7314489 DOI: 10.1002/lio2.371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/17/2020] [Accepted: 02/26/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The present study aimed to replicate the finding that vestibular schwannoma (VS) patients with facial paresis experience lower health related quality of life (QoL) than those without facial paresis in a Dutch sample, and to extend these findings by measuring VS patients' overall satisfaction with life, social function, and emotion. METHODS Forty-seven VS patients, differing in degree of facial functioning, half of them with and half of them without a facial paresis, answered questionnaires about health related QoL (SF-36 and PANQOL), overall satisfaction with life, fear of being evaluated negatively by others, social avoidance and distress, and characteristics and symptoms of depression. RESULTS We observed that VS patients with facial paresis experience lower health-related QoL as well negatively impacted social function and emotion compared to VS patients without facial paresis. VS patients with facial paresis experienced lower overall satisfaction with life, more characteristic symptoms of depression, and more fear of being evaluated negatively by others than VS patients without facial paresis. CONCLUSION These findings corroborate previous research showing an association between impaired facial functioning and lower QoL, but also extend them by showing differences on the quality of social function and emotion. Being aware of this difference between VS patients with and without facial paresis informs health practitioners regarding the specific support these patients might need. Moreover, it is also relevant to consider the influence of a facial paresis on patients' life when deciding between treatment options and in case of surgery the type of resection. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Stephanie S. A. H. Blom
- Department of PsychologyUtrecht University, Martinus J. LangeveldgebouwUtrechtThe Netherlands
| | - Henk Aarts
- Department of PsychologyUtrecht University, Martinus J. LangeveldgebouwUtrechtThe Netherlands
| | - Capi C. Wever
- Department of Otolaryngology—Head & Neck SurgeryLeiden University Medical CenterLeidenThe Netherlands
| | - Henricus P. M. Kunst
- Department of OtolaryngologyRadboud Institute for Health Sciences, Radboud University Medical CenterNijmegenThe Netherlands
- Department of OtolaryngologyMaastricht UMC+MaastrichtThe Netherlands
| | - Gün R. Semin
- Department of PsychologyUtrecht University, Martinus J. LangeveldgebouwUtrechtThe Netherlands
- Department of Psychology, William James Center for Research, ISPA—Instituto UniversitárioLisbonPortugal
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A systematic review on the Derriford Appearance Scale (DAS) questionnaire in surgical research. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01660-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Long-term quality of life in patients with vestibular schwannoma managed with microsurgery. The Journal of Laryngology & Otology 2019; 133:953-959. [PMID: 31668161 DOI: 10.1017/s0022215119002172] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Little is known about the long term (greater than 10 years) quality of life in patients with vestibular schwannoma. This study aimed to evaluate long-term outcomes in patients with vestibular schwannoma. METHOD A retrospective cohort study was performed across 2 academic institutions, with patients followed at least 10 years after vestibular schwannoma surgery (2000 to 2007). Telephone interviews were used to assess quality of life using the Glasgow Benefit Inventory and short form 12 item (version 2) health survey. RESULTS A total of 99 out of 110 patients were included. Increasing age and symptom burden were associated with poorer quality of life (p = 0.01 and 0.02, respectively). The presence of imbalance, headache and facial nerve dysfunction were all associated with poorer quality of life scores (p = 0.01, 0.04 and 0.02, respectively). CONCLUSION Identifying and managing post-operative symptoms may improve quality of life in vestibular schwannoma patients and can guide clinical decision making.
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Díaz-Aristizabal U, Valdés-Vilches M, Fernández-Ferreras T, Calero-Muñoz E, Bienzobas-Allué E, Moracén-Naranjo T. Correlación entre deficiencia, afectación psicológica, discapacidad y calidad de vida en la parálisis facial periférica. Neurologia 2019; 34:423-428. [DOI: 10.1016/j.nrl.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/24/2017] [Accepted: 03/05/2017] [Indexed: 12/19/2022] Open
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Correlations between impairment, psychological distress, disability, and quality of life in peripheral facial palsy. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Saadi R, Shokri T, Schaefer E, Hollenbeak C, Lighthall JG. Depression Rates After Facial Paralysis. Ann Plast Surg 2019; 83:190-194. [DOI: 10.1097/sap.0000000000001908] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Chang S, Makarenko S, Despot I, Dong C, Westerberg BD, Akagami R. Differential Recovery in Early- and Late-Onset Delayed Facial Palsy Following Vestibular Schwannoma Resection. Oper Neurosurg (Hagerstown) 2019; 18:34-40. [DOI: 10.1093/ons/opz083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/25/2019] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDDelayed facial palsy (DFP) after resection of vestibular schwannomas (VS) is worsening of facial nerve function after an initially normal postoperative result.OBJECTIVETo characterize different types of DFP, compare recovery rates, and review of series of outcomes in patients following resection of VS.METHODSBetween 2001 and 2017, 434 patients (51% female) with VS underwent resection. We categorized the patients who developed facial palsy into groups based on timing of onset after surgery, immediate facial palsy (IFP), early-onset DFP (within 48 h), and late-onset DFP (after 48 h). Introduction of facial nerve motor-evoked potentials (fMEP) in 2002 and a change of practice utilizing perioperative minocycline in 2005 allowed for historical analysis of these interventions.RESULTSMean age of study cohort was 49.1 yr (range 13-81 yr), with 19.8% developing facial palsy. The late-onset DFP group demonstrated a significantly faster recovery than the early-onset DFP group (2.8 ± 0.5 vs 47 ± 8 wk, P < .0001), had prolonged latency to palsy onset after initiating perioperative minocycline (7.3 vs 12.5 d, P = .001), and had a nonsignificant trend towards faster recovery from facial palsy with use of minocycline (2.6 vs 3.4 wk, P = .11).CONCLUSIONGiven the timings, it is likely axonal degeneration is responsible for early-onset DFP, while demyelination and remyelination lead to faster facial nerve recovery in late-onset DFP. Reported anti-apoptotic properties of minocycline could account for the further delay in onset of DFP, and possibly reduce the rate and duration of DFP in the surgical cohort.
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Affiliation(s)
- Stephano Chang
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Serge Makarenko
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Ivan Despot
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Charles Dong
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Brian D Westerberg
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
| | - Ryojo Akagami
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada
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Outcomes of large vestibular schwannomas following subtotal resection: early post-operative volume regression and facial nerve function. J Neurooncol 2019; 143:281-288. [PMID: 30989621 DOI: 10.1007/s11060-019-03157-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Subtotal resection (STR) of vestibular schwannoma (VS) tumors remains controversial and little is known regarding post-operative volume changes. METHODS Authors retrospective reviewed the medical records from January 1st 2002 to January 1st 2018, for all patients who had undergone primary STR of large VS at a single tertiary academic institution. RESULTS Our series consists of 34 patients with a mean age of 53.9 (median 53; range 21-87) years that had STR of their VS tumor. The mean pre-operative tumor diameter and volume was 3.9 cm (median 3.0 cm; range 1.6-6.0 cm) and 11.7 cm3 (median 9.6 cm3; range 2.8-44.3 cm3), respectively, with a mean extent of resection of 86% (median 90%; range 53-99%). The mean radiographic and clinical follow-up was 40 months (range 6-120 months) and 51 months (range 7-141 months), respectively. 85% of patients had optimal House-Brackmann (HB) scores (Grade 1 & 2) immediately post-operatively, and 91% at 1 year; 94% of patients had normal (HB 1) at last follow-up. There was significant regression of residual tumor volume at 1 year (p = 0.006) and 2 years (p = 0.02), but not at 3 years (p = 0.08), when compared to the prior year. There was significant regression of size over time, with a mean slope estimate of - 0.70 units per year (p < 0.001). CONCLUSION Excellent clinical facial nerve outcomes can be obtained with STR of large VS tumors. Maximal reduction in tumor size occurs at 2-year post-operatively. Thus, in patients undergoing surgery for large VS, STR and a "watch and wait" strategy is a reasonable treatment option that may optimize facial nerve outcomes.
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Hebb ALO, Erjavec N, Morris DP, Mulroy L, Bance M, Shoman N, Walling S. Quality of life related to symptomatic outcomes in patients with vestibular schwannomas: A Canadian Centre perspective. Am J Otolaryngol 2019; 40:236-246. [PMID: 30554886 DOI: 10.1016/j.amjoto.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022]
Abstract
Patients with vestibular schwannomas (VS) typically present with hearing loss and tinnitus as well as variable cranial nerve dysfunctions. Surgical resection, stereotactic radiotherapy and/or conservative management employing serial magnetic resonance or computed tomography imaging serve as the main treatment options. Quality of life (QoL) may be impacted by the extent of tumour burden and exacerbated or relieved by treatment. Subjective assessment and quality of life inventories provide valuable information in client centered approaches with important implications for treatment. The intention of QoL measurements affecting VS patients within a clinical setting is to facilitate discussions regarding treatment options and objectively evaluate patient- centered clinical outcomes in a naturalistic setting.
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Affiliation(s)
- Andrea L O Hebb
- Division of Neurosurgery, QEII Halifax Infirmary Site, 3rd Floor, 1796 Summer Street, Halifax, NS B3H 3A7, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada.
| | - Niki Erjavec
- Division of Neurosurgery, QEII Halifax Infirmary Site, 3rd Floor, 1796 Summer Street, Halifax, NS B3H 3A7, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
| | - David P Morris
- OtolaryngologyHead & Neck Surgery, QEII Dickson Building, 3rd Floor, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
| | - Liam Mulroy
- Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, Room 2204 Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
| | - Manohar Bance
- Division of Otology and Neurosciences, University of Cambridge, Box 48, ENT Dept, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom of Great Britain
| | - Nael Shoman
- OtolaryngologyHead & Neck Surgery, QEII Dickson Building, 3rd Floor, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
| | - Simon Walling
- Division of Neurosurgery, QEII Halifax Infirmary Site, 3rd Floor, 1796 Summer Street, Halifax, NS B3H 3A7, Canada; Maritime Lateral Skull Base Clinic: Divisions of Neurosurgery, OtolaryngologyHead & Neck Surgery, Canada; Department of Radiation Oncology, Dalhousie University, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS B3H 1Y9, Canada
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Kim S, Lee HY, Kim NK, Yook TH, Seo ES, Kim JU. The association between paralytic side and health-related quality of life in facial palsy: a cross-sectional study of the Korea National Health and Nutrition Examination Survey (2008-2012). Health Qual Life Outcomes 2018; 16:213. [PMID: 30453961 PMCID: PMC6245704 DOI: 10.1186/s12955-018-1038-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/29/2018] [Indexed: 01/09/2023] Open
Abstract
Background Facial palsy is known to have correlations with low level of quality of life. However, little is known about the association between preference based health-related quality of life (HRQoL) and paralytic side of facial palsy. Methods This study used Korea National Health and Nutrition Examination Survey (KNHANES, 2008–2012) data, only when the facial palsy examination had been included in the survey contents. Hierarchical regression analyses were used to obtain optimal regression coefficients in the association between paralytic side of the facial palsy and HRQoL measured by EuroQoL-5 Dimension (EQ-5D). We also analyzed the association between the deteriorated domains of EQ-5D and facial palsy in both subgroups by using multiple logistic regression models. Results We included the data of 28,106 participants aged ≥19 years who were examined as facial palsy according to House-Brackmann score and completed EQ-5D questionnaire in KNHANES 2008–2012. The mean EQ-5D score was significantly low and percentages of deteriorated numbers in its domains were significantly high in facial palsy group. Conclusions These results show that, after adjusting for confounding variables, left facial palsy is associated with impaired HRQoL compared with right-sided palsy. Among the domains of EQ-5D, only ‘self-care’ domain was directly affected by the disease in left facial palsy patients. These findings could be used in developing model and conducting analyses of economic evaluation about facial palsy interventions.
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Affiliation(s)
- Sina Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan, Gyeongnam, South Korea
| | - Hye-Yoon Lee
- National Clinical Research Center for Korean Medicine, Pusan National University Korean Medicine Hospital, Yangsan, South Korea
| | - Nam-Kwen Kim
- Center for Comparative Effectiveness Research & Economic Evaluation in Korean Medicine, Pusan National University, Yangsan, Gyeongnam, South Korea. .,Department of Korean Medicine, Pusan National University, Yangsan, Gyeongnam, South Korea.
| | - Tae Han Yook
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, Jeonju, South Korea.
| | - Eun-Sung Seo
- Department of Food and Nutrition, Seoul National University, Seoul, South Korea
| | - Jong Uk Kim
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, Jeonju, South Korea
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Tavares-Brito J, van Veen MM, Dusseldorp JR, Bahmad F, Hadlock TA. Facial Palsy-Specific Quality of Life in 920 Patients: Correlation With Clinician-Graded Severity and Predicting Factors. Laryngoscope 2018; 129:100-104. [PMID: 30208215 DOI: 10.1002/lary.27481] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/03/2018] [Accepted: 07/09/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the correlation between facial palsy severity and quality of life in a broad cohort of facial palsy patients and to elucidate factors that influence this relationship. STUDY DESIGN Retrospective study. METHODS Records of patients presenting with a clinician-graded facial function (eFACE) and facial palsy-specific quality-of-life patient-reported outcome measure (FaCE) scale from the same moment were reviewed. Multiple linear regression was performed to study the effect of various variables on FaCE total score. RESULTS A total of 920 of 1,304 patients were included, 59.9% female with a mean (standard deviation) age of 48.6 (16.7) years and a median (interquartile range palsy duration of 9.6 [2.2; 42.2] months. A multiple linear regression model predicting FaCE total score was established, finding 10 significant variables: eFACE; viral, malignant, and congenital etiologies; overweight status; anxiety; chronic pain; previous treatment; radiotherapy; and duration of palsy (R2 = 0.261, P < 0.001). Gender, age, laterality, surgical etiology, depression, and timing of evaluation (at initial intake or at follow up) were not found to predict FaCE total scores. CONCLUSION A correlation between facial palsy severity and quality of life was found in a large cohort of patients comprising various etiologies. Additionally, novel factors that predict quality of life in facial palsy were revealed. This information may help specialists to predict which facial palsy patients are at higher risk of a poorer quality of life, regardless of severity. LEVEL OF EVIDENCE 4 Laryngoscope, 129:100-104, 2019.
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Affiliation(s)
- Joana Tavares-Brito
- Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A.,Healthy Science School, University of Brasilia, Brasilia, Brazil
| | - Martinus M van Veen
- Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Plastic Surgery, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Joseph R Dusseldorp
- Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Plastic and Reconstructive Surgery, Royal Australasian College of Surgeons and University of Sydney, Sydney, Australia
| | - Fayez Bahmad
- Healthy Science School, University of Brasilia, Brasilia, Brazil
| | - Tessa A Hadlock
- Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A
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Comprehensive approach to reestablishing form and function after radical parotidectomy. Am J Otolaryngol 2018; 39:542-547. [PMID: 29907429 DOI: 10.1016/j.amjoto.2018.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/06/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The reconstructive goals following radical parotidectomy include restoration of symmetry, reanimation of the face, and reestablishment of oral competence. We present our experience utilizing the anterolateral thigh (ALT) free flap, orthodromic temporalis tendon transfer (OTTT), and facial nerve cable grafting to reestablish form and function. MATERIAL AND METHODS From 2010 to 2016, 17 patients underwent radical parotidectomy followed by immediate reconstruction. An ALT was harvested to accommodate the volume and skin defect. Additional fascia lata and motor nerve to vastus lateralis (MNVL) were obtained. Anastomosis of the ALT to recipient vessels was performed, most commonly using the facial artery and internal jugular vein. OTTT was performed by securing the medial tendon of the temporalis to orbicularis oris through a nasolabial incision. Fascia lata was tunneled through the lower lip, then secured laterally to the temporalis tendon. The MNVL was cable grafted from either the proximal facial nerve or masseteric nerve to the distal facial nerve branches. ALT fascia was suspended to the superficial muscular aponeurotic system. RESULTS Average follow up was 19 months. Only one patient failed to achieve symmetry attributed to dehiscence of OTTT. All patients achieved oral competence and dynamic smile with OTTT activation. Facial nerve recovery was seen in 8 patients. 5 reached a House Brackman Score of 3. Two donor site seromas and two wound infections occurred. CONCLUSION Simultaneous ALT, OTTT, and facial nerve cable grafting provides early reestablishment of facial symmetry, facial reanimation, and oral competence with minimal morbidity.
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Nellis JC, Ishii LE, Boahene KDO, Byrne PJ. Psychosocial Impact of Facial Paralysis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0196-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Györi E, Przestrzelski C, Pona I, Hagmann M, Rath T, Radtke C, Tzou CHJ. Quality of life and functional assessment of facial palsy patients: A questionnaire study. Int J Surg 2018; 55:92-97. [PMID: 29787803 DOI: 10.1016/j.ijsu.2018.04.061] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Facial palsy leads to functional and aesthetic deficits, which impair the quality of life of affected patients. General health-related and disease-specific questionnaires are available for quality of life assessment. In this study, observer-based analysis of facial function (Sunnybrook Facial Grading Scale) was compared patient-based to facial palsy-specific gradings (Facial Clinimetric Evaluation Scale and Facial Disability Index), and general health-related quality of life questionnaires (SF-36). We hypothesized that only facial palsy-specific instruments capture functional and social impairments of affected patients. METHODS Thirty facial palsy patients treated at a tertiary referral centre were included in this study. Inclusion criteria were unilateral facial palsy with stable facial function, age over 18 years and fluency in German. Facial function was assessed with general and disease-specific patient-reported outcome measures and subsequently evaluated by the treating facial plastic surgeon. Statistical analysis included descriptive statistics for all assessed measurements. Correlations were calculated to compare general and facial palsy-specific instruments, as well as observer-based grading. RESULTS Observer-based evaluation of facial function correlated well to the patients-based assessment of physical function, however social subscores did not correlate demonstrating the limited correlation of patient distress and facial nerve impairment. Physical function scores of disease-specific instruments did not correlate with general health assessment scores, while social function scores showed moderate to good correlations. CONCLUSION Validated disease-specific instruments are essential for the assessment of facial palsy patients. Patient-reported outcome measures like the FaCE Scale and the Facial Disability Index should be applied in addition to standardized observer-based ratings to capture the patients' perspective on functional and social impairments associated with facial palsy to fully assess the burden of disease.
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Affiliation(s)
- Eva Györi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christopher Przestrzelski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Igor Pona
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Michael Hagmann
- Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Thomas Rath
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christine Radtke
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - C-H John Tzou
- Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior Vienna (Krankenhaus Goettlicher Heiland), Dornbacher Strasse 20-28, 1170 Vienna, Austria.
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Long-term Quality of Life Following Vestibular Schwannoma Excision Via the Translabyrinthine Approach. Otol Neurotol 2018; 38:1165-1173. [PMID: 28806327 DOI: 10.1097/mao.0000000000001507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess postoperative quality of life (QOL) and other patient-reported outcomes following surgery for vestibular schwannoma. STUDY DESIGN Cross-sectional retrospective case review using postal questionnaires. SETTING Tertiary referral center. PATIENTS Five hundred consecutive patients undergoing surgery for vestibular schwannoma. INTERVENTION(S) Patients undergoing surgery via the translabyrinthine approach (excluding neurofibromatosis type 2) under the senior author, with a minimum of 5 years follow-up, were included. MAIN OUTCOME MEASURE(S) QOL was assessed using the Short Form 36 (SF-36) questionnaire and a disease-specific survey to assess patients' subjective outcomes. RESULTS The SF-36 scores in this group were significantly lower than the general UK population, though 24% of respondents reported a subjective improvement in overall QOL. Tumors larger than 4 cm were related to a reduced SF-36 total mental component score (p = 0.037). Increased age at time of surgery correlated with a reduced physical component of QOL (correlation coefficient = -0.26) and an improved mental component (correlation coefficient = 0.26). Subjective reports of postoperative symptoms and return to work, driving and social activities were similar to other published studies. 35% of patients reported vivid dreams or nightmares following surgery; the first reported incidence of this phenomenon in a large group of vestibular schwannoma patients. CONCLUSIONS Generic measures of QOL in patients following translabyrinthine surgery for vestibular schwannoma do not always match subjective reports, reflecting the complexity of QOL assessment and the range of outcomes in this group. Increased time since surgery appears to be associated with an improvement in mental health.
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The impact of acoustic neuroma on long-term quality-of-life outcomes in the United Kingdom. Eur Arch Otorhinolaryngol 2018; 275:709-717. [DOI: 10.1007/s00405-018-4864-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 01/03/2018] [Indexed: 11/28/2022]
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Bakr MM, Thompson CM, Massadiq M. Anatomical sciences: A foundation for a solid learning experience in dental technology and dental prosthetics. ANATOMICAL SCIENCES EDUCATION 2017; 10:395-404. [PMID: 27585370 DOI: 10.1002/ase.1650] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/24/2016] [Accepted: 08/07/2016] [Indexed: 05/08/2023]
Abstract
Basic science courses are extremely important as a foundation for scaffolding knowledge and then applying it in future courses, clinical situations as well as in a professional career. Anatomical sciences, which include tooth morphology, oral histology, oral embryology, and head and neck anatomy form a core part of the preclinical courses in dental technology programs. In this article, the importance and relevance of anatomical sciences to dental personnel with no direct contact with patients (dental technicians) and limited discipline related contact with patients (dental prosthetists) is highlighted. Some light is shed on the role of anatomical sciences in the pedagogical framework and its significance in the educational process and interprofessional learning of dental technicians and prosthetists using oral biology as an example in the dental curriculum. To conclude, anatomical sciences allow dental technicians and prosthetists to a gain a better insight of how tissues function, leading to a better understanding of diagnosis, comprehensive treatment planning and referrals if needed. Patient communication and satisfaction also increases as a result of this deep understanding of oral tissues. Anatomical sciences bridge the gap between basic science, preclinical, and clinical courses, which leads to a holistic approach in patient management. Finally, treatment outcomes are positively affected due to the appreciation of the macro and micro structure of oral tissues. Anat Sci Educ 10: 395-404. © 2016 American Association of Anatomists.
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Affiliation(s)
- Mahmoud M Bakr
- School of Dentistry and Oral Health, Griffith University, Southport, Queensland, Australia
| | - C Mark Thompson
- School of Dentistry and Oral Health, Griffith University, Southport, Queensland, Australia
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Tseng CC, Hu LY, Liu ME, Yang AC, Shen CC, Tsai SJ. Bidirectional association between Bell's palsy and anxiety disorders: A nationwide population-based retrospective cohort study. J Affect Disord 2017; 215:269-273. [PMID: 28359982 DOI: 10.1016/j.jad.2017.03.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/01/2017] [Accepted: 03/24/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Bell's palsy and anxiety disorders share numerous risk factors (e.g., immune response, ischemia, and psychological stress). However, there have been no studies on the bidirectional temporal association between the two illnesses. In this study, we used the Taiwan National Health Insurance Research Database (NHIRD) to test the bidirectional association between Bell's palsy and anxiety disorders. We hypothesized that patients with Bell's palsy would have an increased risk of subsequent anxiety disorders later in life and that, conversely, those with anxiety disorders would have an increased likelihood of developing Bell's palsy later in life. METHODS We conducted two retrospective cohort studies using Taiwan's National Health Insurance Research Database (NHIRD). Study 1 included 8070 patients diagnosed with anxiety disorders and 32,280 controls without anxiety disorders who were matched with sex, age, and enrollment date to analyze the following risk of Bell's palsy among both groups. Study 2 included 4980 patients with Bell's palsy and 19,920 controls without Bell's palsy who were matched with sex, age, and enrollment date to analyze the following risk of anxiety disorders among both groups. The patient records selected for the studies were dated between January 1, 2000, and December 31, 2004. All subjects were observed until their outcomes of interest, death or December 31, 2009. RESULTS After adjustment for age, sex, comorbidities, urbanization, and income, the hazard ratio (HR) for patients with anxiety disorders to contract Bell's palsy was 1.53 (95% CI, 1.21-1.94, P<.001), and the HR for patients with Bell's palsy to develop an anxiety disorder was 1.59 (95% CI, 1.23-2.06, P<.001). CONCLUSION This study found a bidirectional temporal association between Bell's palsy and anxiety disorders. After one of these conditions develops, the morbidity rate for the other significantly increases. Additional studies are required to determine whether these two conditions share the same pathogenic mechanisms, and whether successfully treating one will reduce the morbidity rate for the other.
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Affiliation(s)
- Chih-Chieh Tseng
- Department of Psychiatry, Beitou branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mu-En Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Albert C Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Che Shen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
| | - Shih-Jen Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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