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Kollar B, Weiss JBW, Kiefer J, Eisenhardt SU. Functional Outcome of Dual Reinnervation with Cross-Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis. Plast Reconstr Surg 2024; 153:1178e-1190e. [PMID: 37384874 DOI: 10.1097/prs.0000000000010888] [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: 07/01/2023]
Abstract
BACKGROUND The combination of cross-facial nerve graft (CFNG) and masseteric nerve transfer (MNT) for reinnervation of facial paralysis may provide advantages of both neural sources. However, quantitative functional outcome reports with a larger number of patients are lacking in the literature. Here, the authors describe their 8-year experience with this surgical technique. METHODS Twenty patients who presented with complete facial paralysis (duration, <12 months) received dual reinnervation with CFNG and MNT. The functional outcome of the procedure was evaluated with the physician-graded outcome metric eFACE scale. The objective artificial intelligence-driven software Emotrics and FaceReader were used for oral commissure measurements and emotional expression assessment, respectively. RESULTS The mean follow-up was 31.75 ± 23.32 months. In the eFACE score, the nasolabial fold depth and oral commissure at rest improved significantly ( P < 0.05) toward a more balanced state after surgery. Postoperatively, there was a significant decrease in oral commissure asymmetry while smiling (from 19.22 ± 6.1 mm to 12.19 ± 7.52 mm). For emotional expression, the median intensity score of happiness, as measured by the FaceReader software, increased significantly while smiling (0.28; interquartile range, 0.13 to 0.64). In five patients (25%), a secondary static midface suspension with fascia lata strip had to be performed because of unsatisfactory resting symmetry. Older patients and patients with greater preoperative resting asymmetry were more likely to receive static midface suspension. CONCLUSION The authors' results suggest that the combination of MNT and CFNG for reinnervation of facial paralysis provides good voluntary motion and may lessen the use of static midface suspension in the majority of patients. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Branislav Kollar
- From the Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg
| | - Jakob B W Weiss
- From the Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg
| | - Jurij Kiefer
- From the Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg
| | - Steffen U Eisenhardt
- From the Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg
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Shokri T, Patel S, Ziai K, Harounian J, Lighthall JG. Facial synkinesis: A distressing sequela of facial palsy. EAR, NOSE & THROAT JOURNAL 2024; 103:NP382-NP391. [PMID: 34836457 DOI: 10.1177/01455613211054627] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with enduring facial paralysis, there is still a lack of complete understanding of this debilitating condition, leading to functional limitations and decreased quality of life.1 This article reviews the diagnostic assessment, etiology, pathophysiology, rehabilitation, and nonsurgical and surgical treatments for facial synkinesis. METHODS A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "facial," "synkinesis," "palsy," and various combinations of the terms. RESULTS The resultant inability to control the full extent of one's facial movements has functional and psychosocial consequences and may result in social withdrawal with a significant decrease in quality of life. An understanding of facial mimetic musculature is imperative in guiding appropriate intervention. While chemodenervation with botulinum toxin and neurorehabilitation have continued to be the primary treatment strategy for facial synkinesis, novel techniques such as selective myectomy, selective neurolysis, free-functioning muscle transfer, and nerve grafting techniques are becoming increasingly utilized in treatment regimens. Facial rehabilitation, including neuromuscular retraining, soft tissue massage, and relaxation therapy in addition to chemodenervation with botulinum toxin, remains the cornerstone of treatment. In cases of severe, intractable synkinesis and non-flaccid facial paralysis, surgical interventions, including selective neurectomy, selective myectomy, nerve grafting, or free muscle transfer, may play a more significant role in alleviating symptoms. DISCUSSION A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes. Ultimately, therapy should be tailored to the severity and pattern of synkinesis, and each patient approached on a case-by-case basis. A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes.
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Affiliation(s)
- Tom Shokri
- Facial Plastic and Reconstructive Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
| | - Jonathan Harounian
- Department of Otolaryngology-Head and Neck Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Jessyka G Lighthall
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, The Pennsylvania State University, Hershey, PA, USA
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Kaufman Goldberg T, Flynn JP, Xiao R, Trzcinski LO, Hadlock TA. Favorable Outcome Perception in Facial Selective Neurectomy. Otolaryngol Head Neck Surg 2024; 170:1045-1050. [PMID: 38050420 DOI: 10.1002/ohn.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Facial selective neurectomy (SN) improves facial function by denervation of muscles antagonistic to the smile in nonflaccid facial paralysis (NFFP) patients. This study aims to assess whether and which objective facial function metrics affect favorable SN outcome in NFFP patients, as perceived by facial nerve (FN) practitioners. STUDY DESIGN Retrospective cohort study. SETTING NFFP patients who underwent SN at the facial nerve center. METHODS Standardized preoperative and postoperative facial photographs of patients undergoing SN were analyzed using clinician-graded measures (eFACE) and automated facial measurement (Emotrics). Favorable outcome was ranked subjectively by 3 independent FN practitioners. Correlations between objective metrics and favorable subjective outcome were examined. RESULTS Fifty-eight SN cases were included. Oral commissure excursion with smile, interlabial distance, and lower lip movement were all considered statistically significantly important for favorable outcome perception. Each +1 mm of smile excursion increases the odds of a favorable outcome by 75.4% (odds ratio [OR]: 1.754). Each +1 mm of interlabial distance asymmetry decreases the odds of a favorable outcome by 24.7% (OR: 0.753). Each +1-point change in lower lip movement eFACE score increases the odds of a favorable outcome by 2.7% (OR: 1.027). CONCLUSION Several smile metrics contribute to favorable SN outcome perception among FN practitioners. Smile excursion, interlabial distance, and lower lip movement were significant predictors of success. These observations may be extrapolated to other facial reanimation interventions and serve surgeons and patients during counseling and expectation management, and during surgery.
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Affiliation(s)
- Tal Kaufman Goldberg
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John P Flynn
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Roy Xiao
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Kaufman-Goldberg T, Flynn JP, Trzcinski LO, McGonagle ER, Banks CA, Hadlock TA. Pre-Operative Factors May Predict Outcome in Selective Neurectomy for Synkinesis. Facial Plast Surg Aesthet Med 2024; 26:166-171. [PMID: 37738387 DOI: 10.1089/fpsam.2022.0412] [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: 09/24/2023] Open
Abstract
Background: While there has been great interest in offering selective neurectomy (SN) to patients with nonflaccid facial palsy (NFFP), postoperative outcomes are inconsistent. Objective: To assess overall SN outcome in NFFP patients and to examine correlation between preoperative factors and SN outcome. Methods: SN cases were retrospectively identified between 2019 and 2021. Patient factors and facial function were assessed using chart review, the Facial Clinimetric Evaluation (FaCE), the electronic clinician-graded facial function tool (eFACE), and an automated computer-aided facial assessment tool (Emotrics). Correlations between preoperative factors and patients outcome were established. Results: Fifty-eight SN cases were performed; 88% were females, and median age was 53 years (range 11-81). Outcome assessment was 8 months on average (1-24 months). Postoperatively, multiple eFACE and Emotrics parameters improved significantly, including ocular, perioral, and synkinesis metrics. In preoperative factors assessment, age >50, facial palsy (FP) duration >2 years, poor preoperative facial function, and nontrauma etiology all correlated with greater improvements compared with younger patients, those with shorter duration facial palsy, trauma etiology, and better preoperative facial function. Conclusions: SN can significantly improve facial function; we have identified several preoperative factors that correlated to outcome.
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Affiliation(s)
- Tal Kaufman-Goldberg
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John P Flynn
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elizabeth R McGonagle
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Caroline A Banks
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Mato-Patino T, Sánchez-Cuadrado I, Peñarrocha J, Morales-Puebla JM, Díez-Sebastián J, Gavilán J, Lassaletta L. Validation of the Spanish version of the Electronic Facial Palsy Assessment (eFACE). Eur Arch Otorhinolaryngol 2024; 281:673-682. [PMID: 37535079 PMCID: PMC10796419 DOI: 10.1007/s00405-023-08132-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE The clinician-graded electronic facial paralysis assessment (eFACE) is a relatively new digital tool for assessing facial palsy. The present study aimed to determine the validity and reliability of the Spanish version of the eFACE. METHODS Forward-backward translation from the original English version was performed. Videos and photographs from 65 adult patients with unilateral facial paralysis (any severity, time course, and etiology) were evaluated twice by five otolaryngologists with varying levels of experience in facial palsy evaluation. Internal consistency was measured using Cronbach's α and the intra- and inter-rater reliability were measured using intraclass correlation coefficient. Concurrent validity was established by calculating Spearman's rho correlation (ρ) between the eFACE and the House-Brackmann scale (H-B) and Pearson's correlation (r) between the eFACE and the Sunnybrook Facial Grading System (SFGS). RESULTS The Spanish version of the eFACE showed good internal consistency (Cronbach's α > 0.8). The intra-rater reliability was nearly perfect for the total score (intraclass correlation coefficient: 0.95-0.99), static score (0.92-0.96), and dynamic score (0.96-0.99) and important-to-excellent for synkinesis score (0.79-0.96). The inter-rater reliability was excellent for the total score (0.85-0.93), static score (0.80-0.90), and dynamic score (0.90-0.95) and moderate-to-important for the synkinesis score (0.55-0.78). The eFACE had a very strong correlation with the H-B (ρ = - 0.88 and - 0.85 for each evaluation, p < 0.001) and the SFGS (r = 0.92 and 0.91 each evaluation, p < 0.001). CONCLUSION The Spanish version of the eFACE is a reliable and valid instrument for assessment of facial function in the diagnosis and treatment of patients with facial paralysis.
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Affiliation(s)
- Teresa Mato-Patino
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain.
- PhD Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain.
| | - Isabel Sánchez-Cuadrado
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain
- IdiPAZ Research Institute, Madrid, Spain
| | - Julio Peñarrocha
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain
- IdiPAZ Research Institute, Madrid, Spain
- Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III (CIBERER-U761), Madrid, Spain
| | | | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain
- IdiPAZ Research Institute, Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, Madrid, Spain
- IdiPAZ Research Institute, Madrid, Spain
- Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III (CIBERER-U761), Madrid, Spain
- PhD Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
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Hadford SP, Genther DJ, Byrne PJ. Pediatric Facial Reanimation. Facial Plast Surg Clin North Am 2024; 32:169-180. [PMID: 37981412 DOI: 10.1016/j.fsc.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Pediatric facial palsy is rare but severely debilitating and results in profound functional, developmental, psychosocial, and esthetic consequences. Identifying the specific cause of the palsy is important in directing the treatment course. The most common etiologies of pediatric facial palsy are distinct from those of adults. Facial reanimation interventions are targeted to address the zones of the face, with oral/smile rehabilitation the most common region requiring intervention in pediatric patients. Gracilis microneurovascular free tissue transfer is safe and highly effective in the pediatric population, providing significant functional, psychosocial, and esthetic benefits.
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Affiliation(s)
- Stephen P Hadford
- Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA
| | - Dane J Genther
- Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA; Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA
| | - Patrick J Byrne
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA; Chair, Cleveland Clinic Head and Neck Institute, 9500 Euclid Avenue A71, Cleveland, OH 44195, USA; Chief, Cleveland Clinic Integrated Surgical Institute, Cleveland, OH 44195, USA.
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7
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Franz L, Marioni G, Daloiso A, Biancoli E, Tealdo G, Cazzador D, Nicolai P, de Filippis C, Zanoletti E. Facial Surface Electromyography: A Novel Approach to Facial Nerve Functional Evaluation after Vestibular Schwannoma Surgery. J Clin Med 2024; 13:590. [PMID: 38276096 PMCID: PMC10816927 DOI: 10.3390/jcm13020590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Vestibular schwannoma (VS) surgery may cause facial nerve damage. However, a comprehensive evaluation of post-operative facial outcomes may be difficult to achieve. Surface electromyography (sEMG) is a promising non-invasive evaluation tool. However, its use in the follow-up after VS surgery has not been reported yet. The main objective was to develop and validate a new sEMG application specifically for the post-VS surgery setting. Secondary goals were to provide a systematic description of facial muscle activity after VS surgery and assess the association between sEMG parameters and Sunnybrook scale scores. METHODS Thirty-three patients with facial palsy following VS surgery were included. The clinical outcomes (Sunnybrook symmetry, movement, and synkinesis scores) and sEMG parameters (signal amplitude normalized by the maximal voluntary contraction (NEMG) and sEMG synkinesis score (ESS, number of synkinesis per movement sequence)) were evaluated at the end of the follow-up. RESULTS In all tested muscles, NEMG variance was significantly higher on the affected side than the contralateral (variance ratio test, p < 0.00001 for each muscle). In total, 30 out of 33 patients (90.9%) showed an ESS ≥ 1 (median: 2.5, IQR: 1.5-3.0). On the affected side, NEMG values positively correlated with both dynamic and overall Sunnybrook scores (Spearman's model, p < 0.05 for each muscle, except orbicularis oculi). ESS significantly correlated with the Sunnybrook synkinesis score (Spearman's rho: 0.8268, p < 0.0001). CONCLUSIONS We described and preliminarily validated a novel multiparametric sEMG approach based on both signal amplitude and synkinesis evaluation specifically for oto-neurosurgery. Large-scale studies are mandatory to further characterize the semiological and prognostic value of facial sEMG.
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Affiliation(s)
- Leonardo Franz
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Gino Marioni
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Antonio Daloiso
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Elia Biancoli
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Giulia Tealdo
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Diego Cazzador
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Piero Nicolai
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
| | - Cosimo de Filippis
- Phoniatrics and Audiology Unit, Department of Neuroscience (DNS), University of Padova, 31100 Treviso, Italy; (G.M.); (C.d.F.)
| | - Elisabetta Zanoletti
- Otolaryngology Unit, Department of Neuroscience (DNS), University of Padova, 35128 Padova, Italy; (A.D.); (E.B.); (G.T.); (D.C.); (P.N.); (E.Z.)
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Bruins TE, Lammens RF, van Veen MM, Tamási K, Dijkstra PU, Werker PMN, Broekstra DC. Assessing Facial Palsy: Does Feedback Improve Assessment Using the eFACE and Sunnybrook Facial Grading System? Laryngoscope 2024. [PMID: 38217435 DOI: 10.1002/lary.31269] [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: 04/20/2023] [Revised: 11/05/2023] [Accepted: 12/27/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE(S) To explore learning effects when applying the clinician-graded electronic facial function scale (eFACE) and the Sunnybrook Facial Grading System (Sunnybrook). METHODS Surgeons, facial rehabilitation therapists, and medical students were randomly allocated to the eFACE (n = 7) or Sunnybrook (n = 6) and graded 60 videos (Massachusetts Eye and Ear Infirmary open-source standard set); 10 persons with normal facial function and 50 patients with a wide variation of facial palsy severity. Participants received an introduction and individual feedback after each set of 10 videos. Scores were compared to the reference score provided with the set. Multilevel analysis was performed to analyze learning effect. RESULTS A learning effect was only found for the eFACE, with significant difference scores in set 1 and 2 compared to set 6, and no significant difference scores in the following sets. The difference score was associated with the reference score (severity of facial palsy) for eFACE (β = -0.19; SE = 0.04; p < 0.001) and Sunnybrook (β = -0.15; SE = 0.04; p < 0.001). Age of participants was also associated with the difference score in the eFACE group (β = 0.18; SE = 0.03; p < 0.001). No differences in scores were found between groups of participants. CONCLUSION The eFACE showed a learning effect of feedback while the Sunnybrook did not. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Tessa E Bruins
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Romy F Lammens
- 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
| | - Katalin Tamási
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurosurgery, 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
- Sirindhorn School of Prosthetics and Orthotics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - 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
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9
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Kaufman Goldberg T, Trzcinski LO, McGonagle ER, Hadlock TA. Does supercharging with cross-face nerve graft enhance smile in non-flaccid facial paralysis patients undergoing selective neurectomy? Microsurgery 2024; 44:e31118. [PMID: 37772398 DOI: 10.1002/micr.31118] [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: 06/27/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Cross face nerve grafting (CFNG) is a well-established nerve transfer technique in facial reanimation; however, no study has assessed outcome of supercharging the smile with CFNG in patients with synkinesis. The goal of this study was to examine the smile outcome in non-flaccid facial paralysis (NFFP) patients after supercharging with CFNG during selective neurectomy. METHODS NFFP patients who underwent CFNG with end-to-side coaptation to a smile branch on the paralyzed side during selective neurectomy were retrospectively identified and their charts were reviewed. Pre-operative and post-operative facial function was assessed with the electronic clinician-graded facial function tool (eFACE), and an automated computer-aided facial assessment tool (Emotrics). Smile metrics were compared pre-operatively, in early post-operative time (EPO, <6 months), and late post-operative time (LPO, >9 months) when CFNG contribution would be expected. RESULTS Thirteen cases were performed between June 2019 and December 2021. No objective smile metrics improved following supercharging with CFNG. Oral commissure excursion improved by 1.23 points in eFACE (p = .812), and by 0.84 in Emotrtics (p = .187) from EPO to LPO. EFACE dynamic score was improved by 0.08 points from EPO to LPO (p = .969). CONCLUSIONS Using CFNG for supercharging the smile during selective neurectomy in NFFP patients may not enhance smile. Longer term results following supercharging and long term natural history of selective neurectomy should be assessed.
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Affiliation(s)
- Tal Kaufman Goldberg
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elizabeth R McGonagle
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Kaufman Goldberg T, Flynn JP, Trzcinski LO, McGonagle ER, Banks CA, Hadlock TA. Understanding the Relationship Between Facial Nerve Branch Sacrifice and Selective Neurectomy Outcome. Facial Plast Surg Aesthet Med 2024; 26:58-64. [PMID: 37428614 DOI: 10.1089/fpsam.2022.0422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
Introduction: While there is great interest in selective neurectomy (SN) for patients with synkinesis, outcomes can be inconsistent. Objective: To examine the relationships between intraoperative facial nerve branch transection and both postoperative outcome and functional deficits. Methods: SN cases, with minimal follow-up of 4 months, were retrospectively identified between 2019 and 2021; outcome was assessed using FaCE instrument, eFACE and Emotrics. Correlations between intraoperative facial nerve branch preservation or transection, and functional outcome and new functional deficits were examined. Results: Fifty-six cases were performed: 88% were females, and median age was 53 years (range 11-81). Mean follow-up was 19.5 months (range 4-42). Oral commissure excursion improved in patients where all smile branches were preserved, no vertical vector smile branches were transected, and more than three smile antagonist branches were transected. A linear trend between smile antagonist branch sacrifice and favorable smile outcome was found. Lower lip movement was improved in patients in whom more than half of the identified lower lip branches were transected. Thirty percent of patients experienced untoward postoperative functional deficits, from which 47% recovered with interventions. Conclusions: Several correlations between SN intra-operative decisions and outcome were identified; new or worsening functional deficit rate can be high. However, chemodenervation or fillers can help diminish these deficits.
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Affiliation(s)
- Tal Kaufman Goldberg
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John P Flynn
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elizabeth R McGonagle
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Caroline A Banks
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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11
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Kollar B, Weiss JBW, Nguyen CT, Zeller J, Kiefer J, Eisenhardt SU. Secondary dynamic midface reanimation with gracilis free muscle transfer after failed reconstruction attempt: A 15-year experience. J Plast Reconstr Aesthet Surg 2023; 87:318-328. [PMID: 37925922 DOI: 10.1016/j.bjps.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The quantitative outcome of secondary reanimation after a failed primary reconstruction attempt for facial paralysis is rarely reported in the literature. This study aimed to investigate the feasibility of secondary reanimation with gracilis free muscle transfer (GFMT) and whether this outcome is influenced by the primary reconstruction. METHODS Twelve patients with previously failed static procedures (static group, n = 6), temporal muscle transfer (temporal transfer group, n = 2), and GFMT (GFMT group, n = 4) were all secondarily reanimated with GFMT. The clinical outcome was graded with the eFACE metric. The objective oral commissure excursion was measured with Emotrics, and the artificial intelligence software FaceReader evaluated the intensity score (IS) of emotional expression. RESULTS The mean follow-up was 40 ± 27 months. The eFACE metric showed a statistically significant (p < 0.05) postoperative improvement in the dynamic and smile scores across all groups. In the GFMT group, oral commissure with smile (75.75 ± 20.43 points), oral commissure excursion while smiling with teeth showing (32.7 ± 4.35 mm), and the intensity of happiness emotion while smiling without teeth showing (IS of 0.37 ± 0.23) were significantly lower as compared with the static group postoperatively (98.83 ± 2.86 points, p = 0.038; 41.7 ± 4.35 mm, p = 0.025; IS 0.83 ± 0.16, p = 0.01). CONCLUSIONS Our data suggest that secondary dynamic reconstruction with GFMT is feasible should the primary reconstruction fail. The secondary GFMT appears to improve the outcome of primary GFMT; however, the oral commissure excursion while smiling might be lower than that in patients who had static procedures as primary reconstruction.
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Affiliation(s)
- Branislav Kollar
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Jakob B W Weiss
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Cam Tu Nguyen
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Johannes Zeller
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Jurij Kiefer
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Medical Faculty of the University of Freiburg, Freiburg, Germany.
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12
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Hohman MH, Krivda JS, Herr MW, Anderson KG, Bevans SE, Montgomery EA, Robitschek JM, Vincent AG. Composite Sterno-Omohyoid Functional Muscle Transfer for Dual-Vector Smile Reanimation: A Case Series. Facial Plast Surg Aesthet Med 2023. [PMID: 37948552 DOI: 10.1089/fpsam.2023.0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Background: Facial reanimation flaps often add bulk and produce single-vector smiles, and multivector flaps frequently require challenging intramuscular dissection. Objective: To evaluate the effectiveness of sterno-omohyoid flap (SOHF) transfer for dual-vector smile reanimation by measuring upper dental show and oral commissure movement. Methods: SOHF transfers from 2017 to 2020 were retrospectively evaluated using eFACE and Emotrics software. Results: Four patients with flaccid and one with nonflaccid facial paralysis were identified (four females and one male, median age: 39 years (range: 38-65); two acoustic neuromas, two congenital, one temporal bone fracture). Median follow-up was 20 months (range: 14-26). All flaps received masseteric nerves and two had additional cross-face grafts. Four developed contraction [median time to contraction: 5.5 months (range: 3-10)]. Mean oral commissure excursion and dental exposure improvements were 7.6 ± 4.0 mm (p = 0.03) and 2.9 ± 1.8 mm (p = 0.05), respectively. Dynamic, smile, and midface-smile eFACE improvements were 20.3 ± 6.8 (p = 0.007), 25.5 ± 14.5 (p = 0.03), and 50.5 ± 12.0 mm (p = 0.004) points, respectively. Mean SOHF mass was 14 ± 1.7 g. Conclusion: The SOHF is a small flap that provides dual-vector smile reanimation in flaccid and nonflaccid facial paralysis.
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Affiliation(s)
- Marc H Hohman
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Joseph S Krivda
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Marc W Herr
- Otolaryngology-Head & Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Kelly G Anderson
- Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Scott E Bevans
- Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Emily A Montgomery
- Otolaryngology-Head & Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jon M Robitschek
- Otolaryngology-Head & Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Aurora G Vincent
- Otolaryngology-Head & Neck Surgery, Eisenhower Army Medical Center, Augusta, Georgia, USA
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13
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Di Pietro A, Cameron M, Campana V, Leyes L, Zalazar Cinat JAI, Lochala C, Johnson CZ, Hilldebrand A, Loyo M. Efficacy of adding selective electrical muscle stimulation to usual physical therapy for Bell's palsy: immediate and six-month outcomes. Eur J Transl Myol 2023; 33:11630. [PMID: 37877154 PMCID: PMC10811644 DOI: 10.4081/ejtm.2023.11630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/26/2023] Open
Abstract
Bell's palsy is the most common cause of facial paralysis, affecting one in every 60 people in their lifetime. Transcutaneously applied selective electrical muscle stimulation could potentially accelerate recovery from Bell's palsy but this intervention remains controversial. Studies have shown benefit, but concerns for lack of efficacy and potential for worsening synkinesis remain. We performed a prospective controlled trial comparing outcomes at initial recovery and six months later with selective electrical muscle stimulation and usual physical therapy versus usual physical therapy alone in adults with acute Bell's palsy. Outcomes were facial function assessed with the House Brackman and eFACE scales. Outcomes were evaluated at discharge and six months after discharge. Discharge occurred when participants were judged to be fully recovered by their treating therapist and supervisor. 38 adults participated in the study. Participants in the electrical stimulation group achieved maximal recovery twice as fast as the control group (2.5 weeks versus 5.2 weeks) with no significant differences in facial function or synkinesis between groups at any time point. This study is the first human trial of electrical stimulation in Bell's palsy to follow patients 6 months from recovery and supports that selective electrical muscle stimulation accelerates recovery and does not increase synkinesis.
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Affiliation(s)
| | - Michelle Cameron
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; VA Portland Health Care System.
| | - Vilma Campana
- Department of Biomedical Physics, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba.
| | - Laura Leyes
- Department of Kinesiology and Physical Therapy, Universidad Nacional del Nordeste, Corrientes.
| | | | - Carly Lochala
- Department of Rehabilitation, Oregon Health & Science University, Portland, OR, USA; Division of Biokinesiology & Physical Therapy, University of Southern California.
| | - Christopher Z Johnson
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
| | - Andrea Hilldebrand
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA; Portland State University School of Public Health, Portland, OR.
| | - Myriam Loyo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
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14
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Ein L, Trzcinski L, Perry L, Bark KY, Hadlock T, Guarin DL. Embellishing Emotrics for a More Complete Emotion Analysis: Addition of the Nasolabial Fold. Facial Plast Surg Aesthet Med 2023; 25:409-414. [PMID: 36857744 DOI: 10.1089/fpsam.2022.0235] [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: 03/03/2023] Open
Abstract
Background: The nasolabial fold (NLF) greatly contributes to facial aesthetics; changes to NLF depth and vector are disfiguring in patients with facial paralysis (FP). NLF parameters are integral to clinician-graded outcomes, but automated programs currently lack NLF identification capabilities. Objective: To incorporate an automated NLF identification and quantification function into the facial landmark program, Emotrics, and to compare new Emotrics-derived NLF data to clinician-graded electronic facial paralysis assessment (eFACE) data for accuracy. Methods: Photographs of 135 patients with FP were marked bilaterally, using identification markers manually placed on each NLF. A machine learning model was trained to automatically localize the markers using these data. Once Emotrics accurately identified the NLF and its corresponding vector, photographs of 20 additional patients who underwent facial reanimation procedures were assessed by the algorithm. Results: The enhanced Emotrics algorithm successfully identified the NLF, and measured the vector from midline, in a series of patients with FP. NLF vector data closely matched corresponding eFACE parameters. Furthermore, changes in NLF presence and vector were detected following facial reanimation procedures. Conclusion: The Emotrics program now provides critical NLF data, providing objective parameters for clinicians interested in changing NLF dynamics after FP.
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Affiliation(s)
- Liliana Ein
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lauren Trzcinski
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Luke Perry
- Florida Insititute of Technology, Department of Biomedical and Chemical Engineering, Melbourne, Florida, USA
| | - Kee Yoon Bark
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Tessa Hadlock
- Department of Otolaryngology, Division of Facial Plastic and Reconstructive Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Diego L Guarin
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
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15
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Botulinum toxin A treatment in facial palsy synkinesis: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2023; 280:1581-1592. [PMID: 36544062 DOI: 10.1007/s00405-022-07796-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Synkinesis is defined as involuntary movements accompanying by voluntary movements and can occur during the aftermath of peripheral facial palsy, causing functional, aesthetic and psychological problems in the patient. Botulinum toxin A (BTX-A) is frequently used as a safe and effective treatment; however, there is no standardized guideline for the use of BTX-A in synkinesis. The purpose of this article is to review and summarize studies about the BTX-A treatment of synkinesis in patients with a history of peripheral facial palsy; including given dosages, injection sites and time intervals between injections. MATERIALS AND METHODS A multi-database systematic literature search was performed in October 2020 using the following databases: Pubmed, Embase, Medline, and The Cochrane Library. Two authors rated the methodological quality of the included studies independently using the 'Newcastle-Ottawa Quality Assessment Scale' for non-randomised studies' (NOS). RESULTS Four-thousand-five-hundred-and-nineteen articles were found of which 34 studies met the inclusion criteria, in total comprising 1314 patients. Most studies were assessed to be of 'fair' to 'good' methodological quality. The Cohen's kappa (between author FJ and AS) was 0.78. Thirty-one studies investigated the reported dosage injected, 17 studies reported injection location and 17 studies investigated time intervals. A meta-analysis was performed for three studies comprising 106 patients, on the effects of BTX-A treatment on the Synkinesis Assessment Questionnaire (SAQ) scores. The mean difference was 11.599 (range 9.422-13.766), p < 0.01. However, due to inconsistent reporting of data of the included studies, no relationship with the dosage and location could be assessed. CONCLUSIONS Many treatment strategies for synkinesis exist, consisting of varying BTX-A brands, dosages, time intervals and different injection locations. Moreover, the individual complaints are very specific, which complicates creating a standardized chemodenervation treatment protocol. The BTX-A treatment of long-term synkinesis is very individual and further studies should focus on a patient-tailored treatment instead of trying to standardize treatment.
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16
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Kimura KS, Kfoury P, Pepper JP. Evidence-Based Medicine: Facial Reanimation. Facial Plast Surg 2023; 39:266-272. [PMID: 36720255 DOI: 10.1055/a-2023-9051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This article provides a brief historical overview of the assessment instruments that have been developed to categorize the severity of disease in patients with facial palsy. Important advances in the quality of these instruments are discussed. The modern-day instruments that are commonly required for evidence-based patient assessment are then presented, with emphasis on the level of evidence of the studies that describe these instruments.
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Affiliation(s)
- Kyle S Kimura
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Peter Kfoury
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Jon-Paul Pepper
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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17
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Lee ZH, Chang EI, Hanasono MM. Management of the Facial Nerve in the Oncologic Setting. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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18
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Pan DR, Clark NW, Chiang H, Kahmke RR, Phillips BT, Barrett DM. The evolution of facial reanimation techniques. Am J Otolaryngol 2023; 44:103822. [PMID: 36934594 DOI: 10.1016/j.amjoto.2023.103822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
This review article provides an updated discussion on evidence-based practices related to the evaluation and management of facial paralysis. Ultimately, the goals of facial reanimation include obtaining facial symmetry at rest, providing corneal protection, restoring smile symmetry and facial movement for functional and aesthetic purposes. The treatment of facial nerve injury is highly individualized, especially given the wide heterogeneity regarding the degree of initial neuronal insult and eventual functional outcome. Recent advancements in facial reanimation techniques have better equipped clinicians to approach challenging patient scenarios with reliable, effective strategies. We discuss how technology such as machine learning software has revolutionized pre- and post-intervention assessments and provide an overview of current controversies including timing of intervention, choice of donor nerve, and management of nonflaccid facial palsy with synkinesis. We highlight novel considerations to mainstay conservative management strategies and examine innovations in modern surgical techniques with a focus on gracilis free muscle transfer. Innervation sources, procedural staging, coaptation patterns, and multi-vector and multi-muscle paddle design are modifications that have significantly evolved over the past decade.
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Affiliation(s)
- Debbie R Pan
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Nicholas W Clark
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Harry Chiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Russel R Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America
| | - Brett T Phillips
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, NC, United States of America
| | - Dane M Barrett
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, United States of America.
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19
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Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4869. [PMID: 36910737 PMCID: PMC10005829 DOI: 10.1097/gox.0000000000004869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/27/2023] [Indexed: 03/12/2023]
Abstract
We describe a new approach for facial reanimation after skull base tumor resection with known facial nerve sacrifice, involving simultaneous masseter nerve transfer with selective cross facial nerve grafting (CFNG) within days after tumor surgery. This preliminary study compared outcomes of this approach versus a staged procedure involving a masseter nerve "babysitter" performed in a delayed timeline. Methods Patients undergoing masseter nerve transfer and CFNG for facial paralysis after skull base tumor resection were consented to participate in video interviews. Facial Clinimetric Evaluation (FaCE) Scale (0-100) patient-reported outcome, eFACE, and Facial Grading Scale scores were compared. Results Nine patients had unilateral facial paralysis from resection of a schwannoma (56%), acoustic neuroma (33%), or vascular malformation (11%). Five underwent early simultaneous CFNG and masseter nerve transfer (mean 3.6 days after resection), whereas four underwent two-stage reanimation including a babysitter procedure (mean 218 days after resection). Postoperative FaCE scale and Facial Grading Scale scores were similar in both groups (P > 0.05). Postoperative mean eFACE scores were similar for both groups for smile (early: 71.5 versus delayed: 75.5; P = 0.08), static (76.3 versus 82.1; P = 0.32), and dynamic scores (59.7 versus 64.9; P = 0.19); however, synkinesis scores were inferior in the early group (76.4 versus 91.1; P = 0.04). Conclusions Early simultaneous masseter nerve transfer and CFNG provides reanimated movement sooner and in fewer stages than a staged approach in a delayed timeline. The early technique appears to result in similar clinician- and patient-reported outcomes compared with delayed procedures; however, in this preliminary study, the early approach was associated with greater synkinesis, meriting further investigation.
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20
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Ein L, Xiao R, Zhou AS, Hadlock TA. Facial Nerve Exploration for Known or Suspected Transection: The Massachusetts Eye and Ear Experience. Facial Plast Surg Aesthet Med 2022. [PMID: 36516072 DOI: 10.1089/fpsam.2022.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: There is no ideal test to determine likelihood of spontaneous recovery after post-traumatic and postsurgical facial palsy (FP). Objective: Among patients with unexpected FP undergoing facial nerve (FN) exploration for suspected discontinuity, we endeavored to discern whether intraoperative findings, repair type, and time to exploration impact FN recovery, as measured by electronic Facial Clinimetric Evaluation (eFACE) and FaCE scales. Methods: Retrospective cohort study of 42 adult patients who underwent FN exploration. Results: FN injury resulted from either surgery (n = 29) or trauma (n = 13). Average time to repair was 68.4 (standard deviation 79.6) days. Postoperative improvements were observed in total eFACE (73.3-86.5; p < 0.0001) and FaCE (21.5-38.1; p = 0.0214) scores. Distal FN injuries were most common (n = 29) and had best recovery (percentage change in eFACE 57.2% vs. 34.3% main trunk, p = 0.0306). Discontinuity injuries (n = 33) repaired with primary coaptation (n = 18) had noninferior outcomes compared with cable graft repair (n = 16; percentage change in eFACE 49.6% vs. 39.2%, p = 0.3470). Denervation times <3 months yielded better recovery using percentage change in eFACE score (56.9% vs. 33.1%, p = 0.0270). Conclusions: Surgical exploration for unexpected FP allows for direct visualization of anatomical nerve status and timely repair.
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Affiliation(s)
- Liliana Ein
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roy Xiao
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Allen S Zhou
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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21
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A Ready-to-Use Grading Tool for Facial Palsy Examiners—Automated Grading System in Facial Palsy Patients Made Easy. J Pers Med 2022; 12:jpm12101739. [PMID: 36294878 PMCID: PMC9605133 DOI: 10.3390/jpm12101739] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/15/2022] [Accepted: 10/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The grading process in facial palsy (FP) patients is crucial for time- and cost-effective therapy decision-making. The House-Brackmann scale (HBS) represents the most commonly used classification system in FP diagnostics. This study investigated the benefits of linking machine learning (ML) techniques with the HBS. Methods: Image datasets of 51 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2020 and May 2021, were used to build the neural network. A total of nine facial poses per patient were used to automatically determine the HBS. Results: The algorithm had an accuracy of 98%. The algorithm processed the real patient image series (i.e., nine images per patient) in 112 ms. For optimized accuracy, we found 30 training runs to be the most effective training length. Conclusion: We have developed an easy-to-use, time- and cost-efficient algorithm that provides highly accurate automated grading of FP patient images. In combination with our application, the algorithm may facilitate the FP surgeon’s clinical workflow.
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22
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Boschetti CE, Vitagliano R, Staglianò S, Pollice A, Giudice GL, Apice C, Santagata M, Tartaro G, Colella G. Development of an application for mobile phones (App) capable to predict the improvement of the degree House Brackmann scale in patients suffering from iatrogenic facial palsy. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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23
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Knoedler L, Baecher H, Kauke-Navarro M, Prantl L, Machens HG, Scheuermann P, Palm C, Baumann R, Kehrer A, Panayi AC, Knoedler S. Towards a Reliable and Rapid Automated Grading System in Facial Palsy Patients: Facial Palsy Surgery Meets Computer Science. J Clin Med 2022; 11:jcm11174998. [PMID: 36078928 PMCID: PMC9457271 DOI: 10.3390/jcm11174998] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS). Methods: Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm. Results: The algorithm showed an accuracy of 100%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100% vs. 99%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100% vs. 96% vs. 97%). Conclusions: Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon’s workflow.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-151-448-249-58
| | - Helena Baecher
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT 06510, USA
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Philipp Scheuermann
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing Lab, Ostbayrische Technische Hochschule Regensburg, 93053 Regensburg, Germany
| | - Raphael Baumann
- Regensburg Medical Image Computing Lab, Ostbayrische Technische Hochschule Regensburg, 93053 Regensburg, Germany
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Adriana C. Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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24
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Fishman Z, Kiss A, Zuker R, Fialkov J, Whyne C. Measuring 3D facial displacement of increasing smile expressions. J Plast Reconstr Aesthet Surg 2022; 75:4273-4280. [DOI: 10.1016/j.bjps.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/16/2022] [Indexed: 11/29/2022]
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25
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Hasmat S, Low THH, Dusseldorp JR, Mukherjee P, Clark JR. Facial nerve palsy: Narrative review on the importance of the eye and its assessment. Head Neck 2022; 44:2600-2607. [PMID: 35894515 DOI: 10.1002/hed.27151] [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: 04/25/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
New solutions are emerging that address specific facial regions in facial nerve palsy (FNP). However the most dreaded consequence of FNP is paralytic lagophthalmos threatening the eye. A way to prioritize these regions is thus required. A review of the literature is conduced to capture the current concepts in evaluating FNP. Overall, patients are assessed from three perspectives: from the clinician's perspective using validated clinician-based grading instruments, from patient's perspective based on FNP-specific patient-reported outcome measures, and from the perspective of the layperson. The existing tools however provide limited information regarding the relative importance of different regions of the face. The eye appears to be an area of great concern for the patient where most surgical therapies are directed at. Addressing ocular problems in FNP carry a high priority but this is not clearly reflected by the standard systems.
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Affiliation(s)
- Shaheen Hasmat
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Joseph R Dusseldorp
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Payal Mukherjee
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
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Pinkiewicz M, Dorobisz K, Zatoński T. A Comprehensive Approach to Facial Reanimation: A Systematic Review. J Clin Med 2022; 11:jcm11102890. [PMID: 35629016 PMCID: PMC9143601 DOI: 10.3390/jcm11102890] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection. Methodological approach: A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles. Conclusions: A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.
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27
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Kabat Rehabilitation in Facial Nerve Palsy after Parotid Gland Tumor Surgery: A Case-Control Study. Diagnostics (Basel) 2022; 12:diagnostics12030565. [PMID: 35328118 PMCID: PMC8947506 DOI: 10.3390/diagnostics12030565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023] Open
Abstract
Temporary facial nerve palsy after parotid tumor surgery ranges from 14 to 65%, depending on surgery, tumor type, and subsite. The study aimed to evaluate the role of Kabat physical rehabilitation in the outcomes of patients affected by severe facial nerve palsy following parotid gland surgery. The results and clinical data of two groups, Kabat and non-Kabat (control), were statistically compared. Descriptive statistics, the multiple linear regression model, difference in difference approach, and the generalized linear model were used. F-Test, Chi-square test, McFadden R-squared, and adjusted R-squared were used to assess the significance. The results showed that the House–Brackmann (HB) stage of patients who had physiotherapy performed were lower than the control group. The decrease of HB staging in the Kabat group at 3 months was −0.71 on average, thus the probability of having a high HB stage decreased by about 13% using Kabat therapy. The results are statistically significant, and indicated that when the Kabat rehabilitation protocol is performed, mainly in the cases of a high-grade HB score, the patients showed a better and faster improvement in postoperative facial nerve palsy.
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28
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Miller MQ, Hadlock TA, Fortier E, Guarin DL. The Auto-eFACE: Machine Learning-Enhanced Program Yields Automated Facial Palsy Assessment Tool. Plast Reconstr Surg 2021; 147:467-474. [PMID: 33235050 DOI: 10.1097/prs.0000000000007572] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial palsy assessment is nonstandardized. Clinician-graded scales are limited by subjectivity and observer bias. Computer-aided grading would be desirable to achieve conformity in facial palsy assessment and to compare the effectiveness of treatments. This research compares the clinician-graded eFACE scale to machine learning-derived automated assessments (auto-eFACE). METHODS The Massachusetts Eye and Ear Infirmary Standard Facial Palsy Dataset was employed. Clinician-graded eFACE assessment was performed on 160 photographs. A Python script was used to automatically generate auto-eFACE scores on the same photographs. eFACE and auto-eFACE scores were compared for normal, flaccidly paralyzed, and synkinetic faces. RESULTS Auto-eFACE and eFACE scores differentiated normal faces from those with facial palsy. Auto-eFACE produced significantly lower scores than eFACE for normal faces (93.83 ± 4.37 versus 100.00 ± 1.58; p = 0.01). Review of photographs revealed minor facial asymmetries in normal faces that clinicians tend to disregard. Auto-eFACE reported better facial symmetry in patients with flaccid paralysis (59.96 ± 5.80) and severe synkinesis (62.35 ± 9.35) than clinician-graded eFACE (52.20 ± 3.39 and 54.22 ± 5.35, respectively; p = 0.080 and p = 0.080, respectively); this result trended toward significance. CONCLUSIONS Auto-eFACE scores can be obtained automatically using a freely available machine learning-based computer software. Automated scores predicted more asymmetry in normal patients, and less asymmetry in patients with flaccid palsy and synkinesis, compared to clinician grading. Auto-eFACE is a quick and easy-to-use assessment tool that holds promise for standardization of facial palsy outcome measures and may eliminate observer bias seen in clinician-graded scales. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, III.
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Affiliation(s)
- Matthew Q Miller
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School; and the Biomedical Engineering Program, Florida Institute of Technology
| | - Tessa A Hadlock
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School; and the Biomedical Engineering Program, Florida Institute of Technology
| | - Emily Fortier
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School; and the Biomedical Engineering Program, Florida Institute of Technology
| | - Diego L Guarin
- From the Massachusetts Eye and Ear Infirmary, Harvard Medical School; and the Biomedical Engineering Program, Florida Institute of Technology
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29
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Computerized Sunnybrook facial grading scale (SBface) application for facial paralysis evaluation. Arch Plast Surg 2021; 48:269-277. [PMID: 34024071 PMCID: PMC8143948 DOI: 10.5999/aps.2020.01844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/24/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The Sunnybrook facial grading scale is a comprehensive scale for the evaluation of facial paralysis patients. Its results greatly depend on subjective input. This study aimed to develop and validate an automated Sunnybrook facial grading scale (SBface) to more objectively assess disfigurement due to facial paralysis. METHODS An application compatible with iOS version 11.0 and up was developed. The software automatically detected facial features in standardized photographs and generated scores following the Sunnybrook facial grading scale. Photographic data from 30 unilateral facial paralysis patients were randomly sampled for validation. Intrarater reliability was tested by conducting two identical tests at a 2-week interval. Interrater reliability was tested between the software and three facial nerve clinicians. RESULTS A beta version of the SBface application was tested. Intrarater reliability showed excellent congruence between the two tests. Moderate to strong positive correlations were found between the software and an otolaryngologist, including the total scores of the three individual software domains and composite scores. However, 74.4% (29/39) of the subdomain items showed low to zero correlation with the human raters (κ<0.2). The correlations between the human raters showed good congruence for most of the total and composite scores, with 10.3% (4/39) of the subdomain items failing to correspond (κ<0.2). CONCLUSIONS The SBface application is efficient and accurate for evaluating the degree of facial paralysis based on the Sunnybrook facial grading scale. However, correlations of the software-derived results with those of human raters are limited by the software algorithm and the raters' inconsistency.
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30
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Guyonvarch P, Benmoussa N, Moya-Plana A, Leymarie N, Mangialardi ML, Honart JF, Kolb F. Thoracodorsal artery perforator free flap with vascularized thoracodorsal nerve for head and neck reconstruction following radical parotidectomy with facial nerve sacrifice: Step-by-step surgical technique video. Head Neck 2021; 43:2255-2258. [PMID: 33818833 DOI: 10.1002/hed.26701] [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: 10/07/2020] [Revised: 01/12/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022] Open
Abstract
Oncological surgery of the parotid region sometimes requires the sacrifice of the facial nerve (parotid cancers, extensive skin cancers of the face, soft tissue sarcomas). The sacrificed portion of nerve can be reconstructed by a vascularized nerve graft, especially if the patient must undergo radiotherapy after surgery. In those cases, the facial nerve sacrifice is associated to an important loss of substance from the parotid region (skin, masseter, parotid, and sometimes jaw). Chimeric flap permit the reconstruction at the same time of the external skin, soft tissues for the volume (fat or muscle), nerve, and bone (ramus and angular part of the mandible). An other option was to raise two flaps but it increased the risk of failure (time of surgery, number of anastomosis, etc.). Reconstruction with a chimeric flap appears to be an ideal choice. Based on these observations, we offer our patients at the Gustave Roussy Institute (Villejuif, France) a thoracodorsal artery perforator (TDAP) free flap including the motor nerve of the latissimus dorsi and vascularized by the thoraco-dorsal pedicle, thus allowing reconstruction in a single surgery. The surgical technique is explained with a step-by-step video. Functional outcomes are also shown in the video. The TDAP or chimeric scapulo-dorsal flap with vascularized nerve has many advantages in the facial reanimation of patients suffering from parotid region cancers. This video article explains surgical steps for other teams.
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Affiliation(s)
- Pierre Guyonvarch
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Nadia Benmoussa
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Nicolas Leymarie
- Department of Plastic Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Maria Lucia Mangialardi
- Department of Head and Neck Oncology, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Jean-François Honart
- Department of Plastic Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France
| | - Frederic Kolb
- Department of Plastic Surgery, Gustave Roussy Institute, University Paris Saclay, Villejuif, France.,Department of Plastic Surgery, UC San Diego, University of California, San Diego, California, USA
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31
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Escalante DA, Malka RE, Wilson AG, Nygren ZS, Radcliffe KA, Ruhl DS, Vincent AG, Hohman MH. Determining the Prognosis of Bell's Palsy Based on Severity at Presentation and Electroneuronography. Otolaryngol Head Neck Surg 2021; 166:151-157. [PMID: 33784203 DOI: 10.1177/01945998211004169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the demographics of Bell's palsy and determine how House-Brackmann (HB) grade at nadir and electroneuronography (ENoG) results correlate with HB grade after recovery and development of synkinesis. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care military medical center. METHODS Patients with acute Bell's palsy and adequate follow-up, defined as 6 months or return to HB grade I function, were included. Demographic information, HB scores at nadir and recovery, and ENoG results were collected. RESULTS A total of 112 patient records were analyzed. Ages ranged from 8 to 87 years with peaks at 21 to 25 and 61 to 65 years. Among patients, 16.3% reached a nadir at HB II, 41.9% at HB III, 5.4% at HB IV, 16.3% at HB V, and 20.1% at HB VI. The overall recovery rate was 73.2% to HB I function, 17.0% to HB II, and 9.8% to HB III. The chance of recovery to HB I decreased as the severity of paralysis increased (rs = -1.0, P < .0001). Mean time to recovery to HB I was 6 weeks. Greater degeneration on ENoG suggested worse recovery (rs = 0.62, P = .01). Patients with HB V and VI were most likely to develop synkinesis. CONCLUSION More severe paralysis increased the chance of recovery to HB II or III function. The granularity of this study provides prognostic insights that may inform the counseling of patients with Bell's palsy with respect to prognosis and recovery timeline.
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Affiliation(s)
- Derek A Escalante
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Ronit E Malka
- Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Zachary S Nygren
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | | | - Douglas S Ruhl
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | | | - Marc H Hohman
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
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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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Fabricius J, Kothari SF, Kothari M. Assessment and rehabilitation interventions for central facial palsy in patients with acquired brain injury: a systematic review. Brain Inj 2021; 35:511-519. [PMID: 33645363 DOI: 10.1080/02699052.2021.1890218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: To do a systematic review covering assessments and interventions for central facial palsy (CFP) in patients with acquired brain injury.Methods: PubMed, Embase, Cinahl, PsycInfo, and Web of Science were screened until April 2019. Assessments were defined as clinical- and instrumental tools and rating scales. Interventions were defined as rehabilitation interventions alleviating CFP.Results: 690 articles were screened based on the title and abstract. Interrater agreement was 98.12%. Sixteen articles were included: six clinical trials and 10 observational studies. Assessment: Commonest scale for assessing CFP was the House-Brackmann facial nerve Grading System. Strain gauges for measuring lip and cheek strength were applied in five studies and neurophysiological methods of assessing motor neuron pathways were applied in three studies. Interventions: An oral screen for improving lip strength was reported in three studies. Other interventions reported were neuromuscular electrical stimulation, Castillo Morales therapy, mirror therapy, exercises with electromyography feedback, and acupuncture.Conclusions: Scales for assessing peripheral facial palsy were applied for assessing CFP. Based on neurophysiological differences in the manifestation of peripheral facial palsy and CFP, these scales should be validated in patients with CFP. More studies on interventions for CFP are required before conclusions may be drawn about their effectiveness.
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Affiliation(s)
- Jesper Fabricius
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark
| | - Simple F Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark.,Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Mohit Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Hammel, Denmark.,JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
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e-Health and telemedicine implementation in facial paralysis: challenges and pitfalls. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:429-434. [PMID: 33612973 PMCID: PMC7881343 DOI: 10.1007/s00238-021-01802-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/02/2021] [Indexed: 11/02/2022]
Abstract
During the current Covid-19 pandemic, a lot of changes had to be made in the care of patients with facial nerve paralysis (FNP). FNP is a life-changing condition with effects on both physical (both esthetic and functional) and psychological aspects of the patient's life. Telemedicine could be a suitable alternative in the therapy for these patients, since it is often not possible to travel to outpatient clinics or to have normal face-to-face appointments with treating physicians because of pandemic restrictions. This review provides an overview of the current literature in the treatment of FNP during the pandemic and the role of telemedicine/e-Health. Secondly, we will discuss the challenges and pitfalls of implementing e-Health and telemedicine applications in clinical practice. Level of evidence: Not ratable.
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35
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Taeger J, Bischoff S, Hagen R, Rak K. Utilization of Smartphone Depth Mapping Cameras for App-Based Grading of Facial Movement Disorders: Development and Feasibility Study. JMIR Mhealth Uhealth 2021; 9:e19346. [PMID: 33496670 PMCID: PMC7872839 DOI: 10.2196/19346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/30/2020] [Accepted: 11/30/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For the classification of facial paresis, various systems of description and evaluation in the form of clinician-graded or software-based scoring systems are available. They serve the purpose of scientific and clinical assessment of the spontaneous course of the disease or monitoring therapeutic interventions. Nevertheless, none have been able to achieve universal acceptance in everyday clinical practice. Hence, a quick and precise tool for assessing the functional status of the facial nerve would be desirable. In this context, the possibilities that the TrueDepth camera of recent iPhone models offer have sparked our interest. OBJECTIVE This paper describes the utilization of the iPhone's TrueDepth camera via a specially developed app prototype for quick, objective, and reproducible quantification of facial asymmetries. METHODS After conceptual and user interface design, a native app prototype for iOS was programmed that accesses and processes the data of the TrueDepth camera. Using a special algorithm, a new index for the grading of unilateral facial paresis ranging from 0% to 100% was developed. The algorithm was adapted to the well-established Stennert index by weighting the individual facial regions based on functional and cosmetic aspects. Test measurements with healthy subjects using the app were performed in order to prove the reliability of the system. RESULTS After the development process, the app prototype had no runtime or buildtime errors and also worked under suboptimal conditions such as different measurement angles, so it met our criteria for a safe and reliable app. The newly defined index expresses the result of the measurements as a generally understandable percentage value for each half of the face. The measurements that correctly rated the facial expressions of healthy individuals as symmetrical in all cases were reproducible and showed no statistically significant intertest variability. CONCLUSIONS Based on the experience with the app prototype assessing healthy subjects, the use of the TrueDepth camera should have considerable potential for app-based grading of facial movement disorders. The app and its algorithm, which is based on theoretical considerations, should be evaluated in a prospective clinical study and correlated with common facial scores.
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Affiliation(s)
- Johannes Taeger
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Stefanie Bischoff
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Kristen Rak
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital Würzburg, Würzburg, Germany
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36
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Guarin DL, Yunusova Y, Taati B, Dusseldorp JR, Mohan S, Tavares J, van Veen MM, Fortier E, Hadlock TA, Jowett N. Toward an Automatic System for Computer-Aided Assessment in Facial Palsy. Facial Plast Surg Aesthet Med 2020; 22:42-49. [PMID: 32053425 PMCID: PMC7362997 DOI: 10.1089/fpsam.2019.29000.gua] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Importance: Quantitative assessment of facial function is challenging, and subjective grading scales such as House-Brackmann, Sunnybrook, and eFACE have well-recognized limitations. Machine learning (ML) approaches to facial landmark localization carry great clinical potential as they enable high-throughput automated quantification of relevant facial metrics from photographs and videos. However, the translation from research settings to clinical application still requires important improvements. Objective: To develop a novel ML algorithm for fast and accurate localization of facial landmarks in photographs of facial palsy patients and utilize this technology as part of an automated computer-aided diagnosis system. Design, Setting, and Participants: Portrait photographs of 8 expressions obtained from 200 facial palsy patients and 10 healthy participants were manually annotated by localizing 68 facial landmarks in each photograph and by 3 trained clinicians using a custom graphical user interface. A novel ML model for automated facial landmark localization was trained using this disease-specific database. Algorithm accuracy was compared with manual markings and the output of a model trained using a larger database consisting only of healthy subjects. Main Outcomes and Measurements: Root mean square error normalized by the interocular distance (NRMSE) of facial landmark localization between prediction of ML algorithm and manually localized landmarks. Results: Publicly available algorithms for facial landmark localization provide poor localization accuracy when applied to photographs of patients compared with photographs of healthy controls (NRMSE, 8.56 ± 2.16 vs. 7.09 ± 2.34, p ≪ 0.01). We found significant improvement in facial landmark localization accuracy for the facial palsy patient population when using a model trained with a relatively small number photographs (1440) of patients compared with a model trained using several thousand more images of healthy faces (NRMSE, 6.03 ± 2.43 vs. 8.56 ± 2.16, p ≪ 0.01). Conclusions and Relevance: Retraining a computer vision facial landmark detection model with fewer than 1600 annotated images of patients significantly improved landmark detection performance in frontal view photographs of this population. The new annotated database and facial landmark localization model represent the first steps toward an automatic system for computer-aided assessment in facial palsy. Level of Evidence: 4.
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Affiliation(s)
- Diego L. Guarin
- KITE | Toronto Rehabilitation Institute—University Health Network, Toronto, Canada
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
| | - Yana Yunusova
- KITE | Toronto Rehabilitation Institute—University Health Network, Toronto, Canada
- Department of Speech Language Pathology, University of Toronto, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Canada
| | - Babak Taati
- KITE | Toronto Rehabilitation Institute—University Health Network, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Joseph R. Dusseldorp
- Department of Plastic and Reconstructive Surgery, Royal Australasian College of Surgeons and University of Sydney, Sydney, Australia
| | - Suresh Mohan
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
| | - Joana Tavares
- Faculty of Health Sciences, Brasilia University, Brasilia, Brazil
| | - Martinus M. van Veen
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
| | - Emily Fortier
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
| | - Tessa A. Hadlock
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
| | - Nate Jowett
- Department of Otolaryngology/Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts
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Vaughan A, Gardner D, Miles A, Copley A, Wenke R, Coulson S. A Systematic Review of Physical Rehabilitation of Facial Palsy. Front Neurol 2020; 11:222. [PMID: 32296385 PMCID: PMC7136559 DOI: 10.3389/fneur.2020.00222] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Facial palsy is a frequent and debilitating sequela of stroke and brain injury, causing functional and aesthetic deficits as well as significant adverse effects on quality of life and well-being. Current literature reports many cases of acquired facial palsy that do not recover spontaneously, and more information is needed regarding the efficacy of physical therapies used in this population. Methods: A systematic search of eight electronic databases was performed from database inception to December 2018. Gray literature searches were then performed to identify additional articles. Studies were included if they addressed physical rehabilitation interventions for adults with acquired facial palsy. Reasons for exclusion were documented. Independent data extraction, quality assessment, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Following abstract screening, a total of 13 full-text articles were identified for independent screening by two reviewers. This included four randomized control trials, two non-randomized control trials, one cohort study, and six prospective case series studies. Twelve out of the 13 included studies reported on facial palsy as a sequela of stroke. A total of 539 participants received intervention for facial palsy across the 13 included studies. Therapy design, length and frequency of intervention varied across the studies, and a wide range of outcome measures were used. Improvement on various outcome measures was reported across all 13 studies. The quality of the evidence was low overall, and most studies were found to have high risk of bias. Conclusions: All the studies in this review report improvement of facial movement or function following application of various methods of physical rehabilitation for facial palsy. Methodological limitations and heterogeneity of design affect the strength of the evidence and prevent reliable comparison between intervention methods. Strong evidence supporting physical rehabilitation was not found; well-designed rigorous research is required.
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Affiliation(s)
- Annabelle Vaughan
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Danielle Gardner
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Anna Miles
- Speech Science, The University of Auckland, Auckland, New Zealand
| | - Anna Copley
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Rachel Wenke
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Susan Coulson
- School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Camperdown, NSW, Australia
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Butler DP, De la Torre A, Borschel GH, Hadlock TA, Beurskens C, Bogart K, Cárdenas Mejía A, Coombs C, Copeland J, Diels J, González-Otero T, Graham L, Ishii L, Malhotra R, Martinez A, McKinley L, Robinson MW, Suominen S, Takushima A, Vazquez Curiel E, Wachs FL, Grobbelaar AO. An International Collaborative Standardizing Patient-Centered Outcome Measures in Pediatric Facial Palsy. JAMA FACIAL PLAST SU 2020; 21:351-358. [PMID: 31070677 DOI: 10.1001/jamafacial.2019.0224] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Standardization of outcome measurement using a patient-centered approach in pediatric facial palsy may help aid the advancement of clinical care in this population. Objective To develop a standardized outcome measurement set for pediatric patients with facial palsy through an international multidisciplinary group of health care professionals, researchers, and patients and patient representatives. Design, Setting, and Participants A working group of health care experts and patient representatives (n = 21), along with external reviewers, participated in the study. Seven teleconferences were conducted over a 9-month period between December 3, 2016, and September 23, 2017, under the guidance of the International Consortium for Health Outcomes Measurement, each followed with a 2-round Delphi process to develop consensus. This process defined the scope, outcome domains, measurement tools, time points for measurements, and case-mix variables deemed essential to a standardized outcome measurement set. Each teleconference was informed by a comprehensive review of literature and through communication with patient advisory groups. Literature review of PubMed was conducted for research published between January 1, 1981, and November 30, 2016. Main Outcomes and Measures The study aim was to develop the outcomes and measures relevant to children with facial palsy as opposed to studying the effect of a particular intervention. Results The 21 members of the working group included pediatric facial palsy experts from 9 countries. The literature review identified 1628 papers, of which 395 (24.3%) were screened and 83 (5.1%) were included for qualitative evaluation. A standard set of outcome measurements was designed by the working group to allow the recording of outcomes after all forms of surgical and nonsurgical facial palsy treatments among pediatric patients of all ages. Unilateral or bilateral, congenital or acquired, permanent or temporary, and single-territory or multiterritory facial palsy can be evaluated using this standard set. Functional, appearance, psychosocial, and administrative outcomes were selected for inclusion. Clinimetric and psychometric outcome measurement tools (clinician-, patient-, and patient proxy-reported) and time points for measuring patient outcomes were established. Eighty-six independent reviews of the standard set were completed, and 34 (85%) of the 40 patients and patient representatives and 44 (96%) of the 46 health care professionals who participated in the reviews agreed that the standard set would capture the outcomes that matter most to children with facial palsy. Conclusions and Relevance This international collaborative study produced a free standardized set of outcome measures for evaluating the quality of care provided to pediatric patients with facial palsy, allowing benchmarking of clinicians, comparison of treatment pathways, and introduction of value-based reimbursement strategies in the field of pediatric facial palsy. Level of Evidence NA.
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Affiliation(s)
- Daniel P Butler
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Alethse De la Torre
- Director of Standardisation and Latin America, International Consortium for Health Outcomes Measurement, Mexico City, Mexico
| | - Gregory H Borschel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Harvard Medical School, Boston, Massachusetts
| | - Carien Beurskens
- Section of Physical Therapy, Department of Orthopedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Alexander Cárdenas Mejía
- Division of Plastic and Reconstructive Surgery, Hospital General Dr Manuel Gea Gonzalez, Postgraduate Division, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Christopher Coombs
- Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Jacqueline Diels
- Facial Retraining LLC, Madison, Wisconsin.,Facial Nerve Clinic, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin Hospital and Clinics, Madison
| | | | - Louise Graham
- Patient representative, Brighton, East Sussex, United Kingdom
| | - Lisa Ishii
- Johns Hopkins Hospitals, Baltimore, Maryland
| | - Raman Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, United Kingdom
| | - Adelaida Martinez
- The Portland Hospital for Women and Children, London, United Kingdom
| | - Lisa McKinley
- Facial Paralysis and Bell's Palsy Foundation, Beverly Hills, California
| | - Mara W Robinson
- Facial Nerve Center, Massachussetts Eye and Ear Infirmary, Boston
| | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Akihiko Takushima
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Faye L Wachs
- California State Polytechnic University, Los Angeles
| | - Adriaan O Grobbelaar
- University College London, London, United Kingdom.,The Royal Free Hospital, London, United Kingdom.,Great Ormond Street Hospital, London, United Kingdom
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Vincent AG, Bevans SE, Robitschek JM, Wind GG, Hohman MH. Masseteric-to-Facial Nerve Transfer and Selective Neurectomy for Rehabilitation of the Synkinetic Smile. JAMA FACIAL PLAST SU 2020; 21:504-510. [PMID: 31465094 DOI: 10.1001/jamafacial.2019.0689] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Synkinesis is the involuntary movement of 1 area of the face accompanying volitional movement of another; it is commonly encountered in patients affected by facial palsy. Current treatments for synkinesis include biofeedback for muscular retraining and chemodenervation via the injection of botulinum toxin. Chemodenervation is effective in reducing unwanted muscle movement, but it requires a commitment to long-term maintenance injections and may lose effectiveness over time. A permanent solution for synkinesis remains elusive. Objective To evaluate masseteric-to-facial nerve transfer with selective neurectomy in rehabilitation of the synkinetic smile. Design, Setting, and Participants In this case series, 7 patients at a tertiary care teaching hospital underwent masseteric-to-facial nerve transfer with selective neurectomy for synkinesis between September 14, 2015, and April 19, 2018. The medical records of these patients were retrospectively reviewed and demographic characteristics, facial palsy causes, other interventions used, and changes in eFACE scores were identified. Intervention Masseteric-to-facial nerve transfer. Main Outcomes and Measures Changes in eFACE scores (calculated via numeric scoring of many sections of the face, including flaccidity, normal tone, and hypertonicity; higher scores indicate better function and lower scores indicate poorer function) and House-Brackmann Facial Nerve Grading System scores (range, 1-6; a score of 1 indicates normal facial function on the affected side, and a score of 6 indicates absence of any facial function [complete flaccid palsy] on the affected side). Results Among the 7 patients in the study (6 women and 1 man; median age, 49 years [range, 41-63 years]), there were no postoperative complications; patients were followed up for a mean of 12.8 months after surgery (range, 11.0-24.5 months). Patients experienced a significant improvement in mean (SD) eFACE scores in multiple domains, including smile (preoperative, 65.00 [8.64]; postoperative, 76.43 [7.79]; P = .01), dynamic function (preoperative, 62.57 [15.37]; and postoperative, 75.71 [8.48]; P = .03), synkinesis (preoperative, 52.70 [4.96]; and postoperative, 82.00 [6.93]; P < .001), midface and smile function (preoperative, 60.71 [13.52]; and postoperative, 78.86 [14.70]; P = .02), and lower face and neck function (preoperative, 51.14 [16.39]; and postoperative, 66.43 [20.82]; P = .046). Preoperative House-Brackmann Facial Nerve Grading System scores ranged from 3 to 4, and postoperative scores ranged from 2 to 3; this change was not significant. Conclusion and Relevance This study describes the application of masseteric-to-facial nerve transfer with selective neurectomy for smile rehabilitation in patients with synkinesis, with statistically significant improvement in smile symmetry and lower facial synkinesis as measured with the eFACE tool. This technique may allow for long-term improvement of synkinesis and smile. This study is only preliminary, and a larger cohort will permit more accurate assessment of this therapeutic modality. Level of Evidence 4.
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Affiliation(s)
- Aurora G Vincent
- Division of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Scott E Bevans
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Jon M Robitschek
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas
| | - Gary G Wind
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Marc H Hohman
- Division of Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
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Bedarida V, Qassemyar Q, Temam S, Janot F, Kolb F. Facial functional outcomes analysis after reconstruction by vascularized thoracodorsal nerve free flap following radical parotidectomy with facial nerve sacrifice. Head Neck 2020; 42:994-1003. [PMID: 31976612 DOI: 10.1002/hed.26076] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 12/18/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parotid spread tumor may occasion wide defect with facial nerve sacrifice. We report our one time reconstruction experience of this defect using a thoracodorsal artery perforator and nerve flap (TAPN). METHODS Eight patients underwent a radical parotidectomy with facial nerve sacrifice between February 2010 and June 2016. A single time reconstruction was performed using a thoracodorsal artery perforator and nerve flap, with skin or fat paddle. The thoracodorsal nerve vascularized was harvested and used to reconstruct the facial nerve from the trunk to four until six distal branches. Patients underwent physiotherapy for 3 months at least. Facial outcomes were assessed using House-Brackmann scale and eFACE application. OUTCOMES Mean follow-up was 30 months. No complication occurred on donor site. All patients recovered a complete soft eye closure. No Frey syndrome occurred. CONCLUSION TAPN is adapted to wide and complex parotid defects.
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Affiliation(s)
- Vincent Bedarida
- Head & Neck Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Quentin Qassemyar
- Faculty of Medicine, Sorbonne Université, Paris, France.,Department of Plastic, Reconstructive and burn surgery, Hopital Armand-Trousseau, Paris, France
| | - Stéphane Temam
- Head & Neck Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - François Janot
- Head & Neck Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Frédéric Kolb
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Villejuif, France
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Sánchez-Ocando M, Gavilán J, Penarrocha J, González-Otero T, Moraleda S, Roda JM, Lassaletta L. Facial nerve repair: the impact of technical variations on the final outcome. Eur Arch Otorhinolaryngol 2019; 276:3301-3308. [PMID: 31538238 DOI: 10.1007/s00405-019-05638-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the outcome of facial nerve (FN) reconstruction, the impact of technical variations in different conditions and locations, and the importance of additional techniques in case of suboptimal results. STUDY DESIGN Retrospective study. SETTING University-based tertiary referral center. PATIENTS Between 2001 and 2017, reconstruction of the FN was performed on 36 patients with varying underlying diseases. INTERVENTIONS FN repair was performed by direct coaptation (n = 3) or graft interposition (n = 33). Microsurgical sutures were used in 17 patients (47%) and fibrin glue was used in all cases. Additional reinnervation techniques (hypoglossal-facial or masseter-facial transfers) were performed in five patients with poor results after initial reconstruction. MAIN OUTCOME MEASURES FN function was evaluated using the House-Brackmann (HB) and the electronic clinician-graded facial function (eFACE) grading systems. Minimum follow-up was 12 months. RESULTS FN reconstruction yielded improvement in 83% of patients, 21 patients (58.3%) achieving a HB grade III. The eFACE median composite, static, dynamic and synkinesis scores were 69.1, 78, 53.2, and 88.2 respectively. A tendency towards better outcome with the use of sutures was found, the difference not being significant. All patients undergoing an additional reinnervation procedure achieved a HB grade III, eFACE score being 74.8. CONCLUSIONS FN reconstruction offers acceptable functional results in most cases. No significant differences are expected with technical variations, different locations or conditions. In patients with poor initial results, additional reinnervation techniques should be always considered. The eFACE adds substantial information to the most used HB scale.
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Affiliation(s)
- María Sánchez-Ocando
- Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain.
| | - Javier Gavilán
- Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain
| | - Julio Penarrocha
- Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain
| | - Teresa González-Otero
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Susana Moraleda
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - José María Roda
- Department of Neurosurgery, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital, IdiPAZ Research Institute, Paseo La Castellana #261, 28046, Madrid, Spain.,Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
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Mothes O, Modersohn L, Volk GF, Klingner C, Witte OW, Schlattmann P, Denzler J, Guntinas-Lichius O. Automated objective and marker-free facial grading using photographs of patients with facial palsy. Eur Arch Otorhinolaryngol 2019; 276:3335-3343. [PMID: 31535292 DOI: 10.1007/s00405-019-05647-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/11/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE An automated, objective, fast and simple classification system for the grading of facial palsy (FP) is lacking. METHODS An observational single center study was performed. 4572 photographs of 233 patients with unilateral peripheral FP were subjectively rated and automatically analyzed applying a machine learning approach including Supervised Descent Method. This allowed an automated grading of all photographs according to House-Brackmann grading scale (HB), Sunnybrook grading system (SB), and Stennert index (SI). RESULTS Median time to first assessment was 6 days after onset. At first examination, the median objective HB, total SB, and total SI were grade 3, 45, and 5, respectively. The best correlation between subjective and objective grading was seen for SB and SI movement score (r = 0.746; r = 0.732, respectively). No agreement was found between subjective and objective HB grading [Test for symmetry 80.61, df = 15, p < 0.001, weighted kappa = - 0.0105; 95% confidence interval (CI) = - 0.0542 to 0.0331; p = 0.6541]. Also no agreement was found between subjective and objective total SI (test for symmetry 166.37, df = 55, p < 0.001) although there was a nonzero weighted kappa = 0.2670; CI 0.2154-0.3186; p < 0.0001). Based on a multinomial logistic regression the probability for higher scores was higher for subjective compared to objective SI (OR 1.608; CI 1.202-2.150; p = 0.0014). The best agreement was seen between subjective and objective SB (ICC = 0.34645). CONCLUSIONS Automated Sunnybrook grading delivered with fair agreement fast and objective global and regional data on facial motor function for use in clinical routine and clinical trials.
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Affiliation(s)
- Oliver Mothes
- Department of Computer Science, Friedrich Schiller University Jena, Jena, Germany
| | - Luise Modersohn
- Department of Computer Science, Friedrich Schiller University Jena, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
| | - Carsten Klingner
- Facial Nerve Center, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Facial Nerve Center, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Science, Jena University Hospital, Jena, Germany
| | - Joachim Denzler
- Department of Computer Science, Friedrich Schiller University Jena, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Facial Nerve Center, Jena University Hospital, Jena, Germany.
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The evolving roles of computer-based technology and smartphone applications in facial plastic surgery. Curr Opin Otolaryngol Head Neck Surg 2019; 27:267-273. [DOI: 10.1097/moo.0000000000000557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Tan JR, Coulson S, Keep M. Face-to-Face Versus Video Assessment of Facial Paralysis: Implications for Telemedicine. J Med Internet Res 2019; 21:e11109. [PMID: 30977734 PMCID: PMC6484264 DOI: 10.2196/11109] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with facial nerve paralysis (FNP) experience challenges in accessing health care that could potentially be overcome by telemedicine. However, the reliability of telemedicine has yet to be established in this field. OBJECTIVE This study aimed to investigate the consistency between face-to-face and video assessments of patients with FNP by experienced clinicians. METHODS A repeated-measures design was used. A total of 7 clinicians assessed the FNP of 28 patients in a face-to-face clinic using standardized grading systems (the House-Brackmann, Sydney, and Sunnybrook facial grading systems). After 3 months, the same grading systems were used to assess facial palsy in video recordings of the same patients. RESULTS The House-Brackmann system in video assessment had excellent reliability and agreement (intraclass correlation coefficient [ICC]=0.780; principal component analysis [PCA]=87.5%), similar to face-to-face assessment (ICC=0.686; PCA=79.2%). Reliability of the Sydney system was good to excellent, with excellent agreement face-to-face (ICC=0.633 to 0.834; PCA=81.0%-95.2%). However, video assessment of the cervical branch and synkinesis had fair reliability and good agreement (ICC=0.437 to 0.597; PCA=71.4%), whereas that of other branches had good to excellent reliability and excellent agreement (ICC=0.625 to 0.862; PCA=85.7%-100.0%). Reliability of the Sunnybrook system was poor to fair for resting symmetry (ICC=0.195 to 0.498; PCA=91.3%-100.0%) and synkinesis (ICC=-0.037 to 0.637; PCA=69.6%-87.0%) but was good to excellent for voluntary movement (ICC=0.601 to 0.906; PCA=56.5%-91.3%) in face-to-face and video assessments. Bland-Altman plots indicated normal limits of agreement within ±1 between face-to-face and video-assessed scores only for the temporal and buccal branches of the Sydney system and for resting symmetry in the Sunnybrook system. CONCLUSIONS Video assessment of FNP with the House-Brackmann and Sunnybrook systems was as reliable as face-to-face but with insufficient agreement, especially in the assessment of synkinesis. However, video assessment does not account for the impact of real-time interactions that occur during tele-assessment sessions.
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Affiliation(s)
- Jian Rong Tan
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Susan Coulson
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Melanie Keep
- Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
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Fuller JC, Justicz NS, Kim J, Cheney M, Castrillon R, Hadlock T. A Facial Plastic and Reconstructive Surgery Training Module Using Surgical Simulation for Capacity Building. JOURNAL OF SURGICAL EDUCATION 2019; 76:274-280. [PMID: 30093333 DOI: 10.1016/j.jsurg.2018.06.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/14/2018] [Accepted: 06/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To introduce 3 novel intensive facial plastic and reconstructive surgery teaching modules for surgical capacity building using simulation in a low-middle income country. DESIGN Prospective cohort study. SETTING University-based medical center in Quito, Ecuador. PARTICIPANTS First- and second-year otolaryngology residents in Quito, Ecuador. RESULTS Residents participated in an intensive 3-day teaching program focused on microtia, nasoseptal abnormalities, and facial paralysis that included didactic lectures, simulation workshops, and live surgery. Residents underwent rigorous pre- and postmodule testing including written, oral, and practical examinations in each subject area. All participants completed anonymous feedback surveys with ratings on a Likert scale from 0 (very poor) to 10 (excellent). Nineteen residents completed both pre- and postmodule testing. The training module was successfully implemented and testing performance across all 3 subject areas significantly improved. Resident feedback was exceedingly positive, with average scores for each component ranging from 8.9 to 9.8, with highest scores given to the simulation workshops. The postmodule survey indicated that all residents found the course helpful and they desired additional courses covering more subject areas. CONCLUSIONS Implementation of an intensive surgical training module combining didactics, surgical simulation, and live surgery resulted in the successful transfer of both skills and knowledge. While the long-term benefit of this program is yet to be determined, this model of training may prove to be a useful tool to help address surgical capacity building in the developing world.
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Affiliation(s)
- Jennifer C Fuller
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
| | - Natalie S Justicz
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Jennifer Kim
- Department of Otolaryngology - Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mack Cheney
- Steven C. and Carmella R. Kletjian Foundation Inc, Boston, Massachusetts
| | | | - Tessa Hadlock
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Lee DY, Kim HS, Kim SY, Park KS, Kim YH. Comparison between Subjective Scoring and Computer-Based Asymmetry Assessment in Facial Nerve Palsy. J Audiol Otol 2018; 23:53-58. [PMID: 30518193 PMCID: PMC6348309 DOI: 10.7874/jao.2018.00318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of the present study was to assess the feasibility of a PC-based facial asymmetry assessment program (PC-FAAP) and to compare the results of PC-FAAP with subjective regional scoring by raters in acute unilateral peripheral facial nerve paralysis (FNP). Subjects and. METHODS Participants were divided into 3 groups with 8 participants per group: group I, normal; group II, mild to moderate FNP; and group III, severe FNP. Using the PC-FAAP, the mouth asymmetry ratio (MAR), eyebrow asymmetry ratio (EAR), and complete eye closure asymmetry ratio (CAR) were calculated by comparing the movement of tracking points on both sides. The FNP grading scale (FGS) integrated each score, and the scores were weighted with a ratio of 5:3:2 (MAR:CAR:EAR). Subjective regional scoring was measured on a 0-100 scale score by three otologists. PC-FAAP and subjective scoring were compared in each group regarding the consistency of the results. RESULTS The mean scores of the MAR, EAR, CAR, and FGS of each group were significantly different. PC-FAAP showed significant differences between the three groups in terms of MAR, EAC, CAR, and FGS. PC-FAAP showed more consistent results than subjective assessment (p<0.001). The PC-FAAP was significantly more consistent in group I and group III (p<0.001 and p=0.002, respectively). FGS in group III was the only parameter that showed a more consistent result in PC-FAAP than the subjective scoring (p=0.008). CONCLUSIONS An FNP grading system using a PC-based program may provide more consistent results, especially for severe forms.
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Affiliation(s)
- Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Seok Kim
- Interdisciplinary Program of Bioengineering, Seoul National University, Seoul, Korea
| | - So Young Kim
- Department of Otorhinolaryngology Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kwang Suk Park
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
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Predicting Perceived Disfigurement from Facial Function in Patients with Unilateral Paralysis. Plast Reconstr Surg 2018; 142:722e-728e. [DOI: 10.1097/prs.0000000000004851] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guntinas-Lichius O, Silver CE, Thielker J, Bernal-Sprekelsen M, Bradford CR, De Bree R, Kowalski LP, Olsen KD, Quer M, Rinaldo A, Rodrigo JR, Sanabria A, Shaha AR, Takes RP, Vander Poorten V, Zbären P, Ferlito A. Management of the facial nerve in parotid cancer: preservation or resection and reconstruction. Eur Arch Otorhinolaryngol 2018; 275:2615-2626. [PMID: 30267218 DOI: 10.1007/s00405-018-5154-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/26/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Management of the facial nerve is instrumental in the surgical treatment of parotid cancer. METHODS A literature search was conducted using PubMed and ScienceDirect database. A total of 195 articles were finally included into the analysis, based on relevance, scientific evidence and actuality. RESULTS In the majority of cases the facial nerve is not involved by tumor. In these cases, identification and preservation of the nerve, in addition to complete tumor removal, are essential for successful surgery. When the nerve is infiltrated by tumor, the affected portion of the nerve must be resected as part of radical parotidectomy. Primary nerve reconstruction or other reanimation techniques give the best long-term functional and cosmetic results. A comprehensive diagnostic evaluation with current imaging and electrophysiological studies will provide the surgeon with the best knowledge of the relationship of the facial nerve to the tumor. Several standardized methods are helpful in finding, dissecting and preserving the nerve during parotid cancer surgery. When radical parotidectomy is indicated, the initial diagnostic work-up can assist in defining the need for adjuvant postoperative therapy and facial reanimation. The aim of rehabilitation is to restore tone, symmetry, and movement to the paralyzed face. CONCLUSIONS The surgical management of facial paralysis has undergone many improvements in recent years. This review gives an overview of recent advances in the diagnostic work-up, surgical techniques and any necessary rehabilitation of the facial nerve in parotid cancer surgery.
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Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Facial Nerve Center, Jena University Hospital, Jena, Germany.
- European Salivary Gland Society, Geneva, Switzerland.
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, USA
| | - Jovanna Thielker
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
- Facial Nerve Center, Jena University Hospital, Jena, Germany
| | | | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, USA
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luis P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Miquel Quer
- European Salivary Gland Society, Geneva, Switzerland
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Juan R Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias and Instituto Universitario de Oncología del Principado de Asturias, CIBERONC, Oviedo, Spain
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Clinica Vida, Universidad de Antioquia, Medellín, Colombia
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent Vander Poorten
- European Salivary Gland Society, Geneva, Switzerland
- Otorhinolaryngology-Head and Neck Surgery and Department of Oncology, section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Peter Zbären
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital, Berne, Switzerland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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49
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Robinson MW, Baiungo J. Facial Rehabilitation: Evaluation and Treatment Strategies for the Patient with Facial Palsy. Otolaryngol Clin North Am 2018; 51:1151-1167. [PMID: 30262166 DOI: 10.1016/j.otc.2018.07.011] [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] [Indexed: 10/28/2022]
Abstract
This article describes the most widely used clinician-graded and patient-reported outcome measures, and describes facial rehabilitation strategies for acute and chronic facial palsy, and rehabilitation following dynamic facial reanimation surgery. The multimodality rehabilitation of the facial palsy patient is determined by the extent of facial nerve injury, specific functional deficits, the presence of synkinesis, and the patient's individual goals. Appropriate intervention, including patient education, soft tissue mobilization, neuromuscular reeducation, and chemodenervation, decreases facial tension and improves facial muscle motor control, physical function, facial expression, and quality of life.
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Affiliation(s)
- Mara Wernick Robinson
- Facial Plastic and Reconstructive Surgery Department, Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Facial Nerve Center, 9th Floor, 243 Charles Street, Boston, MA 02114, USA.
| | - Jennifer Baiungo
- Facial Plastic and Reconstructive Surgery Department, Facial Nerve Center, Massachusetts Eye and Ear Infirmary, Facial Nerve Center, 9th Floor, 243 Charles Street, Boston, MA 02114, USA
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50
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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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