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Odedra A, Blumenow W, Dainty J, Dasgupta S, Dominguez-Gonzalez S, Gonzalez-Martin J, Hartley H, Kelly M, McKay VH, Sharma R, Spinty S, Fattah AY. Multidisciplinary Care for Moebius Syndrome and Related Disorders: Building a Management Protocol. J Clin Med 2024; 13:3309. [PMID: 38893020 PMCID: PMC11172851 DOI: 10.3390/jcm13113309] [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: 04/06/2024] [Revised: 05/18/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Moebius syndrome is a collection of orofacial anomalies with highly variable features affecting many different systems but characterised by bilateral facial palsy and absent eye abduction. We largely regard Moebius syndrome as a diagnosis of exclusion. Lack of awareness and knowledge means that children often fall between services, leading to treatment delays and difficulty interfacing with social care and schools, with long-term impact on physical health and psychosocial development. We developed a multidisciplinary team comprising core clinicians (lead physician, geneticist, speech and language therapist, psychologist and specialist nurse) and an expanded group to encompass the other affected systems. The interactions between our specialties lead to the development of a treatment protocol, which we present. The protocol harnesses the aspects of care of children with a range of other rare diseases at a specialised paediatric centre and synthesises them into a holistic approach for MBS and related conditions. Management is sequenced on an "ABC-style" basis, with airway, feeding, vision and speech taking priority in the early years. We define management priorities as airway stabilisation with swallow assessment, ocular surface protection and maintenance of nutritional support. Management principles for issues such as speech, reflux, drooling and sleep issues are outlined. In later years, psychological support has a prominent role geared towards monitoring and interventions for low mood, self-esteem and bullying.
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Affiliation(s)
- Amar Odedra
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Wendy Blumenow
- Department of Speech and Language Therapy, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK;
| | - Jennifer Dainty
- Department of Psychology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Soumit Dasgupta
- Department of Audiology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Susana Dominguez-Gonzalez
- Department of Orthodontics and Paediatric Dentistry, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Jose Gonzalez-Martin
- Department of Ophthalmology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Helen Hartley
- Therapy Department, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Maria Kelly
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Victoria H. McKay
- Department of Genetics, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
| | - Ravi Sharma
- Ear Nose and Throat Department, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Stefan Spinty
- Department of Paediatric Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Adel Y. Fattah
- Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, UK
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Rostami S, Min S, McCann A, Sayers C, Samy R, Collar R, Hsieh TY. The Effectiveness of Facial Neuromuscular Retraining on Patients with Facial Nerve Dysfunction: A Mental Health and Quality of Life Analysis. Facial Plast Surg Aesthet Med 2024. [PMID: 38635958 DOI: 10.1089/fpsam.2023.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Background: Facial muscle dysfunction can have drastic psychosocial effects. Objectives: To evaluate the impacts of customized neuromuscular retraining on mental health, quality of life (QoL), facial muscle function, and synkinesis. Methods: Thirty patients with facial nerve dysfunction completed a course of neuromuscular retraining. Patients' mental health, QoL, facial muscle function, and synkinesis were evaluated using Patient Health Questionnaire (PHQ-9), Facial Clinimetric Evaluation (FaCE) scale, electronic, clinician-graded facial function scale (eFACE), and Synkinesis Assessment Questionnaire (SAQ) at the initial and final visits. Scores were compared before and after treatment. Results: Patients (n = 30) included had a mean age of 59.4 ± 13.4 years (range 32.3-82.8) and were mostly female (22/30, 73.3%). The most common etiology was Iatrogenic facial nerve paralysis (11/20, 36.7%). Most patients had postfacial paralysis synkinesis (15/30, 50%), while 10 had complete flaccid paralysis. The median house-Brackmann score was 2 (range 1-6). The mean duration of facial palsy was 39.5 ± 106.9 (range 1-576 months). The duration of follow-up after the initial treatment session was 5.5 months, including 10 sessions. After neuromuscular retraining median PHQ-9 scores improved from 5 (range 0-25) to 3 (range 0-20) (p = 0.002). Mean FaCE PROM scores increased from 47.7 ± 11.5 to 56.5 ± 8.8 (p = 0.001). The mean eFACE score increased from 55.8 ± 15.1 to 71.7 ± 13.6 (p < 0.001). Median SAQ score was lower at the final visit (34.6 ± 13.4) compared to the initial visit (47.7 ± 17.8; p < 0.001). Conclusion: Customized neuromuscular retraining may improve patient-reported mental health, QoL, and facial muscle function and reduce synkinesis in facial nerve dysfunction.
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Affiliation(s)
- Sara Rostami
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susie Min
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Adam McCann
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Colton Sayers
- Outpatient Rehabilitative Services Department, UCHealth, Cincinnati, Ohio, USA
| | - Ravi Samy
- Division of Otolaryngology/Head and Neck Surgery, Institute for Surgical Excellence, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Ryan Collar
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Tsung-Yen Hsieh
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Choi SG, Oh JS, Myoung H, Seo MH. Bell's palsy after concomitant chemoradiotherapy: a case report and literature review. J Dent Anesth Pain Med 2024; 24:129-135. [PMID: 38584753 PMCID: PMC10995541 DOI: 10.17245/jdapm.2024.24.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
Concomitant chemoradiotherapy (CCRT) treated patients experience various complications. We present a rare case of post-CCRT Bell's palsy and describe its various possible causes, so as to increase awareness among clinicians about Bell's palsy being a CCRT-associated adverse effect. The patient was a 48-year-old man diagnosed with squamous cell carcinoma who presented with post-CCRT Bell's palsy. After radiotherapy for 6 weeks (overall 67.5 Gy) and four rounds of cisplatin chemotherapy, he complained of paralysis of the entire left face. A test was performed 33 days after the last CCRT session to differentiate Bell's palsy from other causative factors. Based on magnetic resonance imaging findings, facial nerve invasion due to tumor size increase was determined to not cause Bell's palsy. Inflammation of the left Eustachian tube was observed. Hence, steroids and famciclovir were administered, which markedly improved the facial paralysis symptoms within 56 days after facial paralysis development. In conclusion, patients can develop Bell's palsy owing to complex effects of various CCRT mechanisms. Although the exact cause of Bell's palsy has not been identified and the effectiveness of drug treatment was questionable in this case, unlikely causative factors should be excluded through various tests and appropriate and timely measures must be adopted.
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Affiliation(s)
- Sul Gi Choi
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Ji Seok Oh
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Mi Hyun Seo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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4
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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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Knoedler L, Alfertshofer M, Simon S, Prantl L, Kehrer A, Hoch CC, Knoedler S, Lamby P. Diagnosing lagophthalmos using artificial intelligence. Sci Rep 2023; 13:21657. [PMID: 38066112 PMCID: PMC10709577 DOI: 10.1038/s41598-023-49006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
Lagophthalmos is the incomplete closure of the eyelids posing the risk of corneal ulceration and blindness. Lagophthalmos is a common symptom of various pathologies. We aimed to program a convolutional neural network to automatize lagophthalmos diagnosis. From June 2019 to May 2021, prospective data acquisition was performed on 30 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany (IRB reference number: 20-2081-101). In addition, comparative data were gathered from 10 healthy patients as the control group. The training set comprised 826 images, while the validation and testing sets consisted of 91 patient images each. Validation accuracy was 97.8% over the span of 64 epochs. The model was trained for 17.3 min. For training and validation, an average loss of 0.304 and 0.358 and a final loss of 0.276 and 0.157 were noted. The testing accuracy was observed to be 93.41% with a loss of 0.221. This study proposes a novel application for rapid and reliable lagophthalmos diagnosis. Our CNN-based approach combines effective anti-overfitting strategies, short training times, and high accuracy levels. Ultimately, this tool carries high translational potential to facilitate the physician's workflow and improve overall lagophthalmos patient care.
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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Cosima C Hoch
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Technical University of Munich (TUM), 81675, Munich, Germany
| | - Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Philipp Lamby
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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6
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Hussain A. Dynamic eyelid reconstruction in facial nerve palsy. Surv Ophthalmol 2023; 68:985-1001. [PMID: 37201598 DOI: 10.1016/j.survophthal.2023.05.003] [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] [Received: 02/19/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
The consequences of facial nerve palsy and the secondary inability of eyelid closure and blink may lead to devastating complications for the patient, including blindness. Reconstruction techniques to improve eyelid position and function can be broadly classified into 'static' and 'dynamic' techniques. Generally, ophthalmologists have been familiar with static procedures such as upper eyelid loading, tarsorrhaphy, canthoplasty, and lower eyelid suspension. Recently, dynamic techniques are being increasingly described for patients who require definitive strategies to improve eyelid function, once the initial critical goals of corneal protection and vision preservation have been achieved. The choice of technique(s) is dependent upon the status of the main protractor of the eyelid region, as well as the age of the patient, the patient's morbidities and expectations, and surgeon preference. This review shall first describe the clinical and surgical anatomy relevant to the ophthalmic consequences of facial paralysis and discuss methods of defining function and outcomes. A comprehensive review of dynamic eyelid reconstruction is then presented with a discussion of the literature. These various techniques may not be familiar to all clinicians. It is important that ophthalmic surgeons are aware of all options available for their patients. Furthermore, eye care providers must have an understanding of when referral may be appropriate to provide timely intervention and optimal chances of recovery.
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Affiliation(s)
- Ahsen Hussain
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada.
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7
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Lassaletta L, Morales-Puebla JM, Molnar D, González-Otero T, Gavilán J. Side-to-End Intratemporal Hypoglossal-to-Facial Transfer. Atlas Oral Maxillofac Surg Clin North Am 2023; 31:9-17. [PMID: 36754510 DOI: 10.1016/j.cxom.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Luis Lassaletta
- Department of Otolaryngology, Hospital Universitario La Paz, IdiPAZ Research Institute, Paseo de la Castellana, 261, Madrid 28046, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), (CIBERER-U761), Institute of Health Carlos III, Madrid, Spain.
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, Hospital Universitario La Paz, IdiPAZ Research Institute, Paseo de la Castellana, 261, Madrid 28046, Spain; Biomedical Research Networking Centre on Rare Diseases (CIBERER), (CIBERER-U761), Institute of Health Carlos III, Madrid, Spain
| | - David Molnar
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical Centre Hungarian Defence Forces, Róbert Károly körút 44, Budapest 1134, Hungary; Department of Anatomy, Histology and Embryology, Semmelweis University, Tűzoltó utca 58, Budapest 1094, Hungary
| | - Teresa González-Otero
- Department of Maxillofacial Surgery, Hospital Universitario La Paz, IdiPAZ Research Institute, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Javier Gavilán
- Department of Otolaryngology, Hospital Universitario La Paz, IdiPAZ Research Institute, Paseo de la Castellana, 261, Madrid 28046, Spain
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8
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Sanchez-Cuadrado I, Mato-Patino T, Morales-Puebla JM, Peñarrocha J, Diez-Sebastian J, Gavilán J, Lassaletta L. Validation of the Spanish version of the Sunnybrook facial grading system. Eur Arch Otorhinolaryngol 2023; 280:543-548. [PMID: 35737100 DOI: 10.1007/s00405-022-07484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/31/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The Sunnybrook facial grading system (SFGS) is one of the most widely employed tools to assess facial function. The present study aimed to determine the validity and reliability of the Spanish language version of the SFGS. METHODS Forward-backward translation from the original English version was performed by fluent speakers of English and Spanish. Videos from 65 patients with facial paralysis (FP) were evaluated twice by five otolaryngologists with experience in FP evaluation. Internal consistency and intra- and inter-rater reliability were assessed. The House-Brackmann scale was used to display concurrent validity which was established by Spearman's rho correlation. RESULTS The Cronbach's α score exceeded 0.70. The intra-rater intraclass correlation coefficient (ICC) was nearly perfect for the composite score (0.96-0.99), voluntary movements (0.97-0.99), and synkinesis (0.91-0.98), and important to almost perfect for symmetry at rest (0.79-0.97). In both evaluations, the inter-rater ICC was higher than 0.90 for the composite score (0.92-0.96) and voluntary movements (0.91-0.96) and slightly lower for symmetry at rest (0.66-0.85) and synkinesis (0.72-0.87). A strong negative correlation was found between the H-B scale and SFGS (Spearman's rho coefficient = - 0.92, p < 0.001) in both evaluations. CONCLUSION The Spanish version of the SFGS is a reliable and valuable instrument for the assessment of facial function in the diagnosis and treatment of patients with FP.
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Affiliation(s)
- Isabel Sanchez-Cuadrado
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain. .,IdiPAZ Research Institute, Madrid, Spain.
| | - Teresa Mato-Patino
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain
| | - José Manuel Morales-Puebla
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III (CIBERER-U761), Madrid, Spain
| | - Julio Peñarrocha
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain
| | | | - Javier Gavilán
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain
| | - Luis Lassaletta
- Department of Otolaryngology, La Paz University Hospital, P° Castellana, 261, 28046, Madrid, Spain.,IdiPAZ Research Institute, Madrid, Spain.,Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III (CIBERER-U761), Madrid, Spain
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9
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Knoedler L, Miragall M, Kauke-Navarro M, Obed D, Bauer M, Tißler P, Prantl L, Machens HG, Broer PN, Baecher H, Panayi AC, Knoedler S, Kehrer A. A Ready-to-Use Grading Tool for Facial Palsy Examiners-Automated Grading System in Facial Palsy Patients Made Easy. J Pers Med 2022; 12:1739. [PMID: 36294878 PMCID: PMC9605133 DOI: 10.3390/jpm12101739] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [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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Affiliation(s)
- Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Maximilian Miragall
- Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT 06510, USA
| | - Doha Obed
- Department of Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Maximilian Bauer
- Faculty of Informatics and Data Science, University of Regensburg, 93053 Regensburg, Germany
| | - Patrick Tißler
- Faculty of Informatics and Data Science, University of Regensburg, 93053 Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Hans-Guenther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Peter Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Munich, 81925 Munich, Germany
| | - Helena Baecher
- 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 Surgery, Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Andreas Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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10
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Trends in Facial Paralysis Management: A National Survey Study. J Craniofac Surg 2022; 33:1754-1761. [PMID: 35949018 DOI: 10.1097/scs.0000000000008725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Advances in operative management, minimally invasive procedures, and physical therapy have allowed for dramatic improvements in functional and cosmetic outcomes in patients with facial paralysis. Our goal was to evaluate the current trends and practice patterns in the diagnosis and management of facial paralysis by provider demographics. MATERIALS AND METHODS An electronic questionnaire was distributed to members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Practice patterns in the diagnosis and treatment were compared by level of training (fellowship-trained facial plastic and reconstructive surgeon versus non-fellowship trained), practice type (academic and private), practice length, patient volume, and presence of a dedicated facial nerve clinic. The bivariate associations of the outcome variables and the stratification factors were analyzed using 2-way contingency tables and Fisher's exact tests. RESULTS The survey was sent to 1129 members of the AAFPRS. The response rate was 11.7% (n=132). Most respondents were fellowship-trained surgeons (79%) in the academic setting (55%), and most have been in practice for more than 10 years (53%). Practice setting and patient volume were the factors most associated with significant variations in management, including the use of facial paralysis grading scales, photography/videography, patient-reported outcome metrics, as well as differences in both noninvasive and surgical management. CONCLUSION Based on the present study, several physician demographic factors may play a role in choosing which diagnostic and treatment options are employed for facial paralysis, with practice setting and patient volume appearing to be the 2 variables associated with the most significant differences.
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11
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"Introduction of a low-cost and automated four-dimensional assessment system of the face.". Plast Reconstr Surg 2022; 150:639e-643e. [PMID: 35791287 DOI: 10.1097/prs.0000000000009453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY Existing automated objective grading systems either fail to consider the face's complex 3D morphology or suffer from poor feasibility and usability. Consumer-based Red Green Blue Depth (RGB-D) sensors and/or smartphone integrated 3D hardware can inexpensively collect detailed four-dimensional facial data in real-time but are yet to be incorporated into a practical system. This study aims to evaluate the feasibility of a proof-of-concept automated 4D facial assessment system using an RGB-D sensor (termed OpenFAS) for use in a standard clinical environment. This study was performed on normal adult volunteers and patients with facial nerve palsy (FNP). The setup consists of the Intel RealSense SR300 connected to a laptop running the OpenFAS application. The subject sequentially mimics the facial expressions shown on screen. Each frame is landmarked, and automatic anthropometric calculations are performed. Any errors during each session were noted. Landmarking accuracy was estimated by comparing the 'ground-truth position' of landmarks annotated manually to those placed automatically. 18 participants were included in the study, nine healthy participants and nine patients with FNP. Each session was standardized at approximately 106 seconds. 61.8% of landmarks were automatically annotated within approximately 1.575mm of their ground-truth locations. Our findings support that OpenFAS is usable and feasible in routine settings, laying down the critical groundwork for a facial assessment system that addresses the shortcomings of existing tools. However, the iteration of OpenFAS presented in this study is undoubtedly nascent with future work including improvements to landmarking accuracy, analyses components, and RGB-D technology required before clinical application.
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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: 16] [Impact Index Per Article: 8.0] [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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Releasing the Smile: Depressor Anguli Oris Excision in the Context of Managing Nonflaccid Facial Palsy. Plast Reconstr Surg 2022; 149:261e-269e. [PMID: 35077425 DOI: 10.1097/prs.0000000000008807] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nonflaccid facial palsy is a debilitating entity characterized by hypertonicity, synkinesis, and hypomobility. Patients with nonflaccid facial palsy often have smile asymmetry and restriction because of disruption of normal vector forces on the modiolus. Excision of the depressor anguli oris can lead to improved oral commissure excursion, smile angle, dental show, and symmetry. METHODS All depressor anguli oris resection cases between January 8, 2018, and December 26, 2019, were reviewed. Patients with postoperative photographs were included in this cohort study. Preoperative and postoperative photographs were analyzed using the Emotrics software program, and changes in oral commissure excursion, smile angle, and dental show were tracked. Clinician-graded facial palsy assessments and patient-reported outcome measures were compared preoperatively and postoperatively using the Electronic Facial Paralysis Assessment and Facial Clinimetric Evaluation Scale, respectively. RESULTS Forty-three patients were included in this study; 79 percent of patients underwent isolated depressor anguli oris resection. Depressor anguli oris resection led to a statistically significant increase in oral commissure median excursion, smile angle, and dental show [3.02 mm (p = 0.015), 1.70 degrees (p = 0.002), and 2.36 mm (p < 0.001), respectively]. Median Electronic Facial Paralysis Assessment and Facial Clinimetric Evaluation Scale instrument scores also improved [6.0 (p = 0.001) and 7.5 (p = 0.013), respectively]. Depressor anguli oris resection also led to more symmetric smiles. No correlation was seen between duration of follow-up and change in metrics. CONCLUSION Depressor anguli oris resection is a minimal-risk procedure that frequently results in improved smile dynamics, smile symmetry, and quality of life in patients with nonflaccid facial palsy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Pouwels S, Sanfilippo S, Owen E, Ingels KJAO, De Jongh FW, Blondeel P, Monstrey SJ. Measuring outcomes in facial palsy treatment: adding extra dimensions to a complex matter. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01937-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Malka R, Miller M, Guarin D, Fullerton Z, Hadlock T, Banks C. Reliability Between In-Person and Still Photograph Assessment of Facial Function in Facial Paralysis Using the eFACE Facial Grading System. Facial Plast Surg Aesthet Med 2020; 23:344-349. [PMID: 33325774 DOI: 10.1089/fpsam.2020.0300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Importance: Assessing facial function using high-quality photographs would improve long-term and objective outcomes tracking in facial palsy, facilitate automated facial grading using artificial intelligence algorithms, and allow for remote follow up. Objective: To determine agreement between in-person and photographic electronic facial function scale (eFACE) assessments, and evaluate inter-rater reliability of photographic eFACE evaluation. Design, Setting, and Participants: Retrospective review of eFACE scores from in-person interviews and standardized photographs using the Massachusetts Eye and Ear (MEE) Standard Facial Palsy Dataset. Main Outcomes and Measures: eFACE total scores and subset scores determined by two experienced facial reanimation surgeons in person and from photographs. Results: Intraclass correlation coefficients for eFACE scores were 0.96 (95% CI 0.94 to 0.97) for total scores, 0.99 (95% CI 0.989 to 0.995) for static scores, 0.82 (95% CI 0.74 to 0.88) for dynamic scores, and 0.98 (95% CI 0.97 to 0.99) for synkinesis scores. Photographic and in-person scores had a mean difference of -0.64 (95% CI -2.05 to 0.77; p = 0.37) for total score, -1.58 (95% CI -4.22 to 1.05; p = 0.24) for the static subset, 0.14 (95% CI -1.70 to 1.97; p = 0.88) for the dynamic subset, and -1.11 (95% CI -3.09 to 0.86; p = 0.26) for the synkinetic subset. Bland-Altman analysis showed no trend for increasing differences in total score or subset scores. Conclusions: eFACE assessment obtained via photographs exhibits excellent inter-rater reliability and strong agreement with in-person assessment, demonstrating facial symmetry in facial palsy patients can be monitored using standardized frontal photographs.
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Affiliation(s)
- Ronit Malka
- Department of Otolaryngology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Matthew Miller
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Diego Guarin
- Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, Florida, USA
| | | | - Tessa Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Caroline Banks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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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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Establishing Photographic Standards for Facial Transplantation: A Systematic Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2834. [PMID: 33154875 PMCID: PMC7605848 DOI: 10.1097/gox.0000000000002834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/17/2020] [Indexed: 12/13/2022]
Abstract
Photography provides a means for objective assessment and dissemination of clinical information. The American Society of Plastic Surgeons (ASPS) and Plastic Surgery Foundation (PSF) published photography guidelines in 2006 to optimize its clinical use. However, photographic documentation of outcomes in facial transplantation (FT) continues to lack standardization. We therefore appraised the current state of FT photography in the peer-reviewed literature. Methods A PubMed search was conducted from July 2005 to July 2019. Studies containing photographs of partial or full FT recipients were included. Non-English language articles, cadaveric and animal studies, technique papers, and case reports were excluded. Data were extracted from 91 articles. Adherence rates were calculated to determine whether published FT photographs followed ASPS/PSF guidelines. Proposed photographic standards particular to FT were then formulated to guide standardization of practice. Results Only 28.6% (26/91) of articles adhered to the photographic conventions of preparation, positioning, and views. Of 162 patient appearances in the 91 articles, 95% (154/162) met the criteria for preparation, 98.8% (160/162) met the criteria for positioning, but only 24.7% (40/162) met the criteria for views. Conclusions Photographic documentation of FT outcomes in the peer-reviewed literature is limited, with inconsistent adherence to ASPS/PSF guidelines. There is substantial deficiency in provision of alternative views, with the majority of publications only depicting the frontal view. FT photography standards should specifically incorporate alternative views, proper lighting and framing, and elimination of distractions, and accommodate for remote patient self-photography. This will promote a transparent and consistent longitudinal evaluation of the surgical results.
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Gibelli D, Tarabbia F, Restelli S, Allevi F, Dolci C, Dell’Aversana Orabona G, Cappella A, Codari M, Sforza C, Biglioli F. Three-dimensional assessment of restored smiling mobility after reanimation of unilateral facial palsy by triple innervation technique. Int J Oral Maxillofac Surg 2020; 49:536-542. [DOI: 10.1016/j.ijom.2019.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/24/2019] [Accepted: 07/19/2019] [Indexed: 01/22/2023]
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Lassaletta L, Morales-Puebla JM, Altuna X, Arbizu Á, Arístegui M, Batuecas Á, Cenjor C, Espinosa-Sánchez JM, García-Iza L, García-Raya P, González-Otero T, Mañós M, Martín C, Moraleda S, Roda JM, Santiago S, Benítez J, Cavallé L, Correia V, Estévez JM, Gómez J, González R, Jiménez J, Lacosta JL, Lavilla MJ, Peñarrocha J, Polo R, García-Purriños F, Ramos F, Tomás M, Uzcanga M, Vallejo LÁ, Gavilán J. Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:99-118. [PMID: 31097197 DOI: 10.1016/j.otorri.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.
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Affiliation(s)
- Luis Lassaletta
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España; Comisión de Otoneurología de la SEORL, Madrid, España; IdiPAZ, Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, España.
| | | | - Xabier Altuna
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Álvaro Arbizu
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, España
| | - Miguel Arístegui
- Servicio de Otorrinolaringología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Ángel Batuecas
- Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, Salamanca, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Carlos Cenjor
- Servicio de Otorrinolaringología, Fundación Jiménez Díaz, Madrid, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Juan Manuel Espinosa-Sánchez
- Servicio de Otorrinolaringología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitariaibs, Granada, España; Comisión de Otoneurología de la SEORL, Madrid, España
| | - Leire García-Iza
- Servicio de Otorrinolaringología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Pilar García-Raya
- Servicio de Neurorradiología, Hospital Universitario La Paz, Madrid, España
| | | | - Manuel Mañós
- Servicio Otorrinolaringología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Carlos Martín
- Servicio de Otorrinolaringología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Susana Moraleda
- Servicio de Rehabilitación, Hospital Universitario La Paz, Madrid, España
| | - Jose María Roda
- Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, España
| | - Susana Santiago
- Servicio de Neurofisiología, Hospital Universitario La Paz, Madrid, España
| | - Jesús Benítez
- Servicio de Otorrinolaringología, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - Laura Cavallé
- Departamento de Otorrinolaringología, Hospital Universitario La Fe, Valencia, España
| | - Victor Correia
- Servicio de Otorrinolaringología, Hospital de CUF de Porto, Porto, Portugal
| | - Jose Manuel Estévez
- Servicio de Otorrinolaringología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, España
| | - Justo Gómez
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Rocío González
- Servicio de Otorrinolaringología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | - Jorge Jiménez
- Servicio de Otorrinolaringología, Complejo Hospitalario de Toledo, Toledo, España
| | - Jose Luis Lacosta
- Servicio de Otorrinolaringología, Hospital San Pedro, Logroño, La Rioja, España
| | - María José Lavilla
- Servicio de Otorrinolaringología, Hospital Lozano Blesa, Zaragoza, España
| | - Julio Peñarrocha
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España
| | - Rubén Polo
- Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Francisco Ramos
- Servicio de Otorrinolaringología, Hospital San Pedro de Alcántara, Cáceres, España
| | - Manuel Tomás
- Servicio de Otorrinolaringología, Hospital Son Espases, Mallorca, Islas Baleares, España
| | - María Uzcanga
- Servicio de Otorrinolaringología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Luis Ángel Vallejo
- Servicio de Otorrinolaringología, Hospital Universitario Río Hortega, Valladolid, España
| | - Javier Gavilán
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España
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Lassaletta L, Morales-Puebla JM, Altuna X, Arbizu Á, Arístegui M, Batuecas Á, Cenjor C, Espinosa-Sánchez JM, García-Iza L, García-Raya P, González-Otero T, Mañós M, Martín C, Moraleda S, Roda JM, Santiago S, Benítez J, Cavallé L, Correia V, Estévez JM, Gómez J, González R, Jiménez J, Lacosta JL, Lavilla MJ, Peñarrocha J, Polo R, García-Purriños F, Ramos F, Tomás M, Uzcanga M, Vallejo LÁ, Gavilán J. Facial Paralysis: Clinical Practice Guideline of the Spanish Society of Otolaryngology. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dusseldorp JR, van Veen MM, Guarin DL, Quatela O, Jowett N, Hadlock TA. Spontaneity Assessment in Dually Innervated Gracilis Smile Reanimation Surgery. JAMA FACIAL PLAST SU 2020; 21:551-557. [PMID: 31670745 DOI: 10.1001/jamafacial.2019.1090] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgeons have sought to optimize outcomes of smile reanimation surgery by combining inputs from nerve-to-masseter and cross-face nerve grafts. An objective assessment tool could help surgeons evaluate outcomes to determine the optimal neural sources for smile reanimation. Objective To evaluate the use of a novel video time-stamping method and standard outcome measurement tools to assess outcomes of facial reanimation surgery using various innervation strategies. Design, Setting, and Participants Cohort study assessing the outcomes of dually innervated gracilis free muscle transfers vs single-source innervated gracilis transfer performed at a tertiary care facial nerve center between 2007 and 2017 using a novel, video time-stamping spontaneity assessment method. The statistical analyses were performed in 2018. Interventions Dually innervated gracilis free muscle transfers or single-source innervated gracilis transfer. Main Outcomes and Measures Spontaneous smiling was assessed by clinicians and quantified using blinded time-stamped video recordings of smiling elicited while viewing humorous video clips. Results This retrospective cohort study included 25 patients (12 men and 13 women; median [range] age, 38.4 [29.3-46.0] years) treated with dually innervated gracilis free functional muscle graft for unilateral facial palsy between 2007 and 2017. Smile spontaneity assessment was performed in 17 patients and was compared with assessment performed in 24 patients treated with single-source innervated gracilis transfer (ie, nerve-to-masseter-driven or cross-face nerve graft-driven gracilis [n = 13]) (demographic data not available for NTM and CFNG cohorts). The use of time-stamped video assessment revealed that spontaneous synchronous oral commissure movement in a median percentage of smiles was 33% in patients with dually innervated gracilis (interquartile range [IQR], 0%-71%), 20% of smiles in patients with nerve-to-masseter-driven gracilis (IQR, 0%-50%), and 75% of smiles in patients with cross-face nerve graft-driven gracilis (IQR, 0%-100%). Clinicians graded smile spontaneity in dually innervated cases as absent in 40% (n = 6 of 15), trace in 33% (n = 5 of 15) and present in 27% (n = 4 of 15). No association was demonstrated between clinician-reported spontaneity and objectively measured synchronicity. Conclusions and Relevance Dually innervated gracilis free muscle transfers may improve smile spontaneity compared with masseteric nerve-driven transfers but not to the level of cross-face nerve graft-driven gracilis transfers. Quantifying spontaneity is notoriously difficult, and most authors rely on clinical assessment. Our results suggest that clinicians may rate presence of spontaneity higher than objective measures, highlighting the importance of standardized assessment techniques. Level of Evidence 4.
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Affiliation(s)
- Joseph R Dusseldorp
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston.,Department of Plastic and Reconstructive Surgery, Royal Australasian College of Surgeons and University of Sydney, Sydney, Australia
| | - Martinus M van Veen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston.,Department of Plastic Surgery, University Medical Center Groningen, and University of Groningen, Groningen, the Netherlands
| | - Diego L Guarin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
| | - Olivia Quatela
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
| | - Nate Jowett
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
| | - Tessa A Hadlock
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
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Three-Dimensional Stereophotogrammetry Assessment of Facial Asymmetry in Facial Palsy. J Craniofac Surg 2020; 31:893-897. [PMID: 32049918 DOI: 10.1097/scs.0000000000006192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Three-dimensional stereophotogrammetry is not much used in assessing facial palsy and a comprehensive understanding of sources of variation in these measurements is lacking. The present study assessed intra- and interobserver reliability of a novel three-dimensional stereophotogrammetry measurement of facial asymmetry and examined sources of variation in these outcomes. Three photographs (rest, closed mouth smile, and maximum smile) were made of 60 participants, 30 facial palsy patients and 30 control subjects. All images were analyzed twice by 2 observers independently, to determine intra- and interobserver reliability. Variance component analysis was performed to investigate sources of variation in the outcomes. Intraobserver reliability was good with intraclass correlation coefficients ranging from 0.715 to 0.999. Interobserver reliability ranged from 0.442 to 0.929. Reliability of the smile image measurements was not clearly different from the rest images. Variation in measurement results was largely due to the status of a participant, facial palsy versus control. When splitting the sample, the facial expression was a major source of variation. Acceptable reliability of the proposed 3D facial asymmetry measurement was found, in facial palsy patients and control subjects. Interobserver reliability was marked less compared to intraobserver reliability. For follow-up data only one observer should assess 3D stereophotogrammetry measurements.
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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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24
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Faris C, Tessler O, Heiser A, Hadlock T, Jowett N. Evaluation of Societal Health Utility of Facial Palsy and Facial Reanimation. JAMA FACIAL PLAST SU 2019; 20:480-487. [PMID: 30178066 DOI: 10.1001/jamafacial.2018.0866] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The severity of a health state may be quantified using health utility measures. The utility of flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome with synkinesis may be challenging to discern from photographs alone. Objective To determine the societal health utility of flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, and post-facial reanimation using standard video. Design, Setting, and Participants This survey study was conducted at the Massachusetts Eye and Ear and the Harvard Decision Science Laboratory from June 14, 2017, to August 3, 2017. Healthy adult naïve observers were recruited through advertising in the Cambridge, Massachusetts, area. Participants (n = 298) completed the web-based, interactive survey in person. The survey comprised clinical vignettes consisting of symptom summaries, videos, and pictures depicting 5 health states. Main Outcomes and Measures Adult naïve observers ranked the utility of 5 randomized health states (flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, post-facial reanimation, monocular blindness, and binocular blindness) according to the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) measures. Standard videos of patients' facial function were used. Results In total, 377 naïve observers were recruited and completed the survey in its entirety. Of the 377 participants, 298 (79.0%) were included for analysis. Among the 298 participants, 151 (50.7%) were female, 146 (49.0%) were male, with a mean (SD) age of 33.0 (15.1) years. No differences in health utility scores (SD) were observed between flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome (VAS: 0.598 [0.213] vs 0.629 [0.207]; SG: 0.714 [0.245] vs 0.748 [0.237]; TTO: 0.716 [0.248] vs 0.741 [0.247]). Both health states rated substantially worse than monocular blindness (VAS: 0.691 [0.212]; SG: 0.817 [0.204]; TTO: 0.826 [0.196]) and post-facial reanimation (VAS: 0.742 [0.189]; SG: 0.833 [0.206]; TTO: 0.838 [0.19]). Conclusions and Relevance Health utility scores for flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome appeared to be equivalent and worse than that for monocular blindness, whereas scores for post-facial reanimation were substantially higher than the scores for the 2 facial movement disorders. These findings may provide insights into the societal advantages of facial reanimation surgery. Level of Evidence NA.
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Affiliation(s)
- Callum Faris
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology and Head and Neck Surgery, Tübingen University, Tübingen, Germany
| | - Oren Tessler
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Louisiana State University Health Sciences Center, New Orleans
| | - Alyssa Heiser
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Tessa Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
| | - Nate Jowett
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Boston.,Harvard Medical School, Boston, Massachusetts
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25
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Affiliation(s)
- Jeffrey T Gu
- Medical student at University of California Irvine School of Medicine.,Beckman Laser Institute, University of California Irvine
| | - Allison Hu
- Medical student at University of California Irvine School of Medicine.,Beckman Laser Institute, University of California Irvine
| | - Connie Oh
- Beckman Laser Institute, University of California Irvine
| | - Brian J F Wong
- Beckman Laser Institute, University of California Irvine.,Department of Otolaryngology-Head and Neck Surgery, University of California Irvine
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26
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Volk GF, Schaede RA, Thielker J, Modersohn L, Mothes O, Nduka CC, Barth JM, Denzler J, Guntinas-Lichius O. Reliability of grading of facial palsy using a video tutorial with synchronous video recording. Laryngoscope 2018; 129:2274-2279. [PMID: 30570149 DOI: 10.1002/lary.27739] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the intrarater, interrater, and retest reliability of facial nerve grading of patients with facial palsy (FP) using standardized videos recorded synchronously during a self-explanatory patient video tutorial. STUDY DESIGN Prospective, observational study. METHODS The automated videos from 10 patients with varying degrees of FP (5 acute, 5 chronic FP) and videos without tutorial from eight patients (all chronic FP) were rated by five novices and five experts according to the House-Brackmann grading system (HB), the Sunnybrook Grading System (SB), and the Facial Nerve Grading System 2.0 (FNGS 2.0). RESULTS Intrarater reliability for the three grading systems was very high using the automated videos (intraclass correlation coefficient [ICC]; SB: ICC = 0.967; FNGS 2.0: ICC = 0.931; HB: ICC = 0.931). Interrater reliability was also high (SB: ICC = 0.921; FNGS 2.0: ICC = 0.837; HB: ICC = 0.736), but for HB Fleiss kappa (0.214) and Kendell W (0.231) was low. The interrater reliability was not different between novices and experts. Retest reliability was very high (SB: novices ICC = 0.979; experts ICC = 0.964; FNGS 2.0: novices ICC = 0.979; experts ICC = 0.969). The reliability of grading of chronic FP with SB was higher using automated videos with tutorial (ICC = 0.845) than without tutorial (ICC = 0.538). CONCLUSION The reliability of the grading using the automated videos is excellent, especially for the SB grading. We recommend using this automated video tool regularly in clinical routine and for clinical studies. LEVEL OF EVIDENCE 4 xsLaryngoscope, 129:2274-2279, 2019.
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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
| | | | - Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Luise Modersohn
- Department of Computer Science, Friedrich-Schiller-University Jena, Jena, Germany
| | - Oliver Mothes
- Department of Computer Science, Friedrich-Schiller-University Jena, Jena, Germany
| | - Charles C Nduka
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, United Kingdom
| | | | - Joachim Denzler
- Department of Computer Science, Friedrich-Schiller-University Jena, 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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27
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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: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Revenaugh PC, Smith RM, Plitt MA, Ishii L, Boahene K, Byrne PJ. Use of Objective Metrics in Dynamic Facial Reanimation. JAMA FACIAL PLAST SU 2018; 20:501-508. [DOI: 10.1001/jamafacial.2018.0398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter C. Revenaugh
- Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ryan M. Smith
- Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Max A. Plitt
- Division of Facial Plastic and Reconstructive Surgery, Department of Otorhinolaryngology–Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois
| | - Lisa Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kofi Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Patrick J. Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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29
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Tollefson TT, Hadlock TA, Lighthall JG. Facial Paralysis Discussion and Debate. Facial Plast Surg Clin North Am 2018; 26:163-180. [PMID: 29636148 DOI: 10.1016/j.fsc.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This article examines 6 questions about facial paralysis answered by 3 experts in their field of facial plastic surgery. The topics covered include routine assessment, neuromuscular training, nonsurgical management, and the future of this field. All the authors answered these questions in a "How I do it" manner to provide the reader with a true understanding of their thoughts and techniques. This article provides a practical resource to all physicians and practitioners treating patients with facial paralysis on some of the most common questions and issues.
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Affiliation(s)
- Travis T Tollefson
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, UC Davis Medical Center, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive H-091, Hershey, PA 17033, USA.
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30
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Joumblat NR, Chim J, Aguirre Sanchez PG, Bedolla E, Salgado CJ. Guidelines for the Standardization of Genital Photography. Aesthet Surg J 2018; 38:1124-1130. [PMID: 29420725 DOI: 10.1093/asj/sjy017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Plastic surgery relies on photography for both clinical practice and research. The Photographic Standards in Plastic Surgery laid the foundation for standardized photography in plastic surgery. Despite these advancements, the current literature lacks guidelines for genital photography, thus resulting in a discordance of documentation. The authors propose photographic standards for the male and female genitalia to establish homogeneity in which information can be accurately exchanged. All medical photographs include a sky-blue background, proper lighting, removal of distractors, consistent camera framing, and standard camera angles. We propose the following guidelines to standardize genital photography. In the anterior upright position, feet are shoulder-width apart, and arms are placed posteriorly. The frame is bounded superiorly by the xiphoid-umbilicus midpoint and inferiorly by the patella. For circumferential documentation, frontal 180 degree capture via 45 degree intervals is often sufficient. Images in standard lithotomy position should be captured at both parallel and 45 degrees above the horizontal. Images of the phallus should include both the flaccid and erect states. Despite the increasing incidence of genital procedures, there lacks a standardized methodology in which to document the genitalia, resulting in a substantial heterogeneity in the current literature. Our standardized techniques for genital photography set forth to establish a uniform language that promotes more effective communication with both the patient as well as with colleagues. The proposed photography guidelines provide optimal visualization and standard documentation of the genitalia, allowing for accurate education, meaningful collaborations, and advancement in genital surgery.
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Affiliation(s)
- Natalie R Joumblat
- Division of Plastic, Reconstructive, Aesthetic and Transgender Surgery, University of Miami Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Jimmy Chim
- Division of Plastic, Reconstructive, Aesthetic and Transgender Surgery, University of Miami Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Priscila Gisselle Aguirre Sanchez
- Division of Plastic, Reconstructive, Aesthetic and Transgender Surgery, University of Miami Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Edgar Bedolla
- Division of Plastic, Reconstructive, Aesthetic and Transgender Surgery, University of Miami Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Christopher J Salgado
- Division of Plastic, Reconstructive, Aesthetic and Transgender Surgery, University of Miami Hospital, University of Miami Miller School of Medicine, Miami, FL
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31
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Thielker J, Geißler K, Granitzka T, Klingner CM, Volk GF, Guntinas-Lichius O. Acute Management of Bell’s Palsy. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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32
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Györi E, Przestrzelski C, Pona I, Hagmann M, Rath T, Radtke C, Tzou CHJ. Quality of life and functional assessment of facial palsy patients: A questionnaire study. Int J Surg 2018; 55:92-97. [PMID: 29787803 DOI: 10.1016/j.ijsu.2018.04.061] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Facial palsy leads to functional and aesthetic deficits, which impair the quality of life of affected patients. General health-related and disease-specific questionnaires are available for quality of life assessment. In this study, observer-based analysis of facial function (Sunnybrook Facial Grading Scale) was compared patient-based to facial palsy-specific gradings (Facial Clinimetric Evaluation Scale and Facial Disability Index), and general health-related quality of life questionnaires (SF-36). We hypothesized that only facial palsy-specific instruments capture functional and social impairments of affected patients. METHODS Thirty facial palsy patients treated at a tertiary referral centre were included in this study. Inclusion criteria were unilateral facial palsy with stable facial function, age over 18 years and fluency in German. Facial function was assessed with general and disease-specific patient-reported outcome measures and subsequently evaluated by the treating facial plastic surgeon. Statistical analysis included descriptive statistics for all assessed measurements. Correlations were calculated to compare general and facial palsy-specific instruments, as well as observer-based grading. RESULTS Observer-based evaluation of facial function correlated well to the patients-based assessment of physical function, however social subscores did not correlate demonstrating the limited correlation of patient distress and facial nerve impairment. Physical function scores of disease-specific instruments did not correlate with general health assessment scores, while social function scores showed moderate to good correlations. CONCLUSION Validated disease-specific instruments are essential for the assessment of facial palsy patients. Patient-reported outcome measures like the FaCE Scale and the Facial Disability Index should be applied in addition to standardized observer-based ratings to capture the patients' perspective on functional and social impairments associated with facial palsy to fully assess the burden of disease.
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Affiliation(s)
- Eva Györi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christopher Przestrzelski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Igor Pona
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Michael Hagmann
- Section for Medical Statistics, CeMSIIS, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Thomas Rath
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christine Radtke
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - C-H John Tzou
- Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior Vienna (Krankenhaus Goettlicher Heiland), Dornbacher Strasse 20-28, 1170 Vienna, Austria.
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