Societal Identification of Facial Paralysis and Paralysis Location

Searching for Signs of Plastic Surgery on the Face: Tracking the Eyes of Where Observers Look

Background: Objective measurement of where observers direct their attention to faces when searching for signs of facial plastic surgery (FPS) is currently lacking. Objective: To compare where laypersons direct their attention on facial photographs using eye-tracking software when they are asked to (1) search for signs of aesthetic facial surgery or (2) allowed to gaze without direction (free-gaze). Methods: Naïve observers either free-gazed or examined faces for signs of FPS (FPS-prompted) for 10 s per face while their gaze was recorded by an eye-tracking system. Faces had no known history or signs/stigmata of FPS and were selected from the FACES and CFD databases with a diverse demographic distribution. Gaze times in nine facial subregions were analyzed using mixed-effects linear regression. Results: In FPS-prompted observers (n = 50, mean age 32.7 ± 11.3 years, 23/50 (46%) female), the nose, mouth, cheeks, and forehead experienced the most substantial increases (p < 0.001) and a high percentage of overall gaze time (17.9%, 12.5%, 12.0%, 9.6%, respectively) compared to free-gazing observers [n = 57, 35.5 ± 13.9 years, 31/57 (54%) female]. Conclusions: Observers direct attention differently on a face when searching for signs of plastic surgery with increased attention on the nose, mouth, cheeks, and forehead.

Newly Prepared 129Xe Nanoprobe-Based Functional Magnetic Resonance Imaging to Evaluate the Efficacy of Acupuncture on Intractable Peripheral Facial Paralysis

This study focused on the application value of the newly prepared 129Xe nanoprobe-based functional magnetic resonance imaging (fMRI) in exploring the mechanism of the acupuncture treatment for intractable facial paralysis, expected to provide a theoretical reference for the mechanism of acupuncture for the treatment of facial paralysis. In this study, 30 patients with intractable peripheral facial paralysis (experimental group) and 30 healthy volunteers (control group) were selected. All patients were scanned by the newly prepared 129Xe nanoprobe-based fMRI technology, and then brain functional status data and rating data were collected. fMRI scanning results showed that multiple brain regions were activated in the experimental group before treatment, among which the central posterior brain, insula, and thalamus were positively activated, while the precuneus, superior frontal gyrus, and other parts showed signal reduction. After treatment, several brain regions also showed signal enhancement. Comparisons within the healthy control group also showed activation in multiple brain regions, including the lenticular nucleus, inferior frontal gyrus, and superior temporal gyrus, while in the experimental group, no signal changes were detected in these brain regions. At the same time, comparison of fMRI images of patients with intractable peripheral facial paralysis before and after treatment showed that the cerebellar amygdala, superior frontal gyrus, cerebellar mountaintop, and other brain areas were activated, and all showed positive activation. After treatment, the average House–Brackmann (H-B) and Sunnybrook scores of the experimental group were 3.82 and 51, respectively, and the change was significant compared with that before treatment (P < 0.05). In conclusion, the newly prepared 129Xe nanoprobe-based fMRI scan can reflect the functional changes of cerebral cortex after acupuncture. The acupuncture treatment may achieve its therapeutic effect by promoting the functional reorganization of the cerebral cortex in the treatment of intractable facial paralysis.

Cosmetic appreciation and emotional processing in patients with a peripheral facial palsy: A systematic review

Background; The goal of this review is 1) to summarize the studies assessing PFP by casual observers, patients themselves and the cosmetic appreciation of the PFP and 2) to summarize the studies assessing whether there is a difference in emotional recognition/processing of facial emotions and/or cognitive tasks in patients with a PFP. Materials and Methods; A multi-database systematic literature search was performed using the following databases: Pubmed, Embase, Medline, and The Cochrane Library from the earliest date of each database up to December 2019. Population of interest consisted of patients with a PFP and studies that investigated cosmetic appreciation and/or emotional recognition and/or emotional processing in these patients. Two authors rated the methodological quality of the included studies independently using the 'Newcastle - Ottawa Quality Assessment Scale' for nonrandomised studies' (NOS). Two authors extracted the outcome data regarding cosmetic appreciation and/or emotional recognition/processing from the included studies. Results; Twelve hundred and thirty-two studies were found of which eleven studies met the inclusion criteria. Most studies were assessed to be of 'fair' to 'good' methodological quality. The Cohen's kappa (between author RL and SP) was 0.68. Two studies investigated emotional processing and/or emotional recognition. Nine studies investigated cosmetic appreciation in both patients and casual observers. Important findings of this systematic review are that there is a correlation between the perceived severity of the PFP of the patients and the ratings by casual observers. Secondly there seems to be a laterality difference in cosmetic appreciation and thirdly there might to be a decreased emotional recognition and processing in patients with a PFP. Conclusion; Emotional recognition and cosmetic appreciation in patients with a PFP is an under investigated area, in which further studies are needed to substantiate the findings in current literature.

Role of Body Dysmorphic Disorder in Patients With Postparalytic Facial Synkinesis

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.

Reliability Between In-Person and Still Photograph Assessment of Facial Function in Facial Paralysis Using the eFACE Facial Grading System

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.