Patient satisfaction after lid loading in facial palsy

Quality of Life in Patients with Unresolved Facial Nerve Palsy and Exposure Keratopathy Treated by Upper Eyelid Gold Weight Loading

Background

Loading of the upper eyelid with gold weights is a well-established procedure for the correction of paralytic lagophthalmos. There is no reliable research evaluating the results of this treatment from the patients’ viewpoint.

Aim

The aim of this research was to evaluate quality of life (QOL) domains through two standardized questionnaires (SF-36 and NEI-VFQ39) in patients treated by upper eyelid gold weight loading compared to healthy individuals (the “healthy” group) as well as patients with other ophthalmologic conditions (the “sick” group).

Patients and Methods

This prospective comparative clinical study of 416 surveys was conducted in 2012–2018. The study group includes 59 people: 40 women, 19 men aged 55.5 ± 17.4 treated with gold weights for corneal complications due to unresolved facial nerve palsy. General QOL was assessed using the SF-36 questionnaire. Eye-related QOL was assessed through the NEI-VFQ39 questionnaire. The results were compared with those obtained in 2 control groups: the “healthy” and the “sick,” 53 individuals each.

Results

A statistically significant increase in QOL domains was noted in patients with facial nerve palsy after treatment (p<0.001). No statistically significant differences were found in categories defining the Physical Component Score in these patients as compared to those from the “sick” control group (p = 0.95). After surgery, the results of the Mental Component Score were comparable to those in the “healthy” control group (p = 0.51). The eye-related health scores changed significantly after surgery and differed significantly compared to the “sick” control group (p <0.05); however, they did not reach the level of the “healthy” control group (p <0.001).

Conclusion

Patients with untreated facial nerve palsy had the lowest QOL levels among all individuals involved in this study. Treatment of lagophthalmos by gold weights significantly improved their QOL, with the greatest impact on mental aspects of health.

The psychosocial impact of facial palsy: A systematic review

PURPOSE

Facial palsy is a condition which can lead to significant changes in facial function and appearance. People with facial palsy often report psychosocial difficulties, including withdrawal from social activities, anxiety, negative body image, and low mood. This paper aimed to review all published research investigating the psychosocial impact of facial palsy on adults.

METHODS

A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, and AMED databases was performed. The quality of included studies was assessed, and data were extracted with regard to characteristics of participants; study methodology and design; outcome measures used; and psychosocial outcomes.

RESULTS

Twenty-seven studies met inclusion criteria. A high proportion of people with facial palsy reported clinically significant levels of anxiety and depression, with greater difficulties typically reported by females, compared to males. Other difficulties consistently reported include low quality of life, poor social function, and high levels of appearance-related distress. Objective severity of facial palsy was consistently shown to not be associated with anxiety or depression, with psychological factors instead likely mediating the relationship between the severity of facial palsy and psychosocial well-being.

CONCLUSIONS

Irrespective of objective symptom severity, facial palsy has the potential to have a significant impact on psychosocial well-being and quality of life. The various methodological limitations of the included studies are discussed, along with clinical implications, including the need for greater access to psychological screening and interventions for people with facial palsy.

Long-Term Outcomes of Upper Eyelid Loading with Platinum Segment Chains for Lagophthalmos: An Adjustable Approach

PURPOSE

This article reports the outcomes of a 5-year series of individually sutured platinum segment chains for upper eyelid loading.

DESIGN

Consecutive case series.

METHODS

Platinum segments of 0.4 and 0.2 g were assembled to create the desired weight and were placed in a supratarsal location after levator aponeurosis recession. Primary outcome measures included lagophthalmos on blink, gentle and forced eyelid closure, upper eyelid margin-to-reflex distance (MRD1), corneal staining, static and dynamic validated scoring for facial palsy patients, and complications. Secondary outcome measures were visual acuity, occurrence of induced ptosis, need for further surgery, cosmesis, and quality of life evaluation.

RESULTS

During 2013-2018, a total of 122 upper eyelids of 117 patients received platinum segment chains (mean weight, 1.2 ± 0.2 g; range, 0.8-1.6 g) for lagophthalmos. Median follow-up was 17.4 months. All grades of lagophthalmos were reduced (P < 0.001), with mean reductions of 3.6, 2.5, and 1.5 mm on blink, gentle, and forced closures, respectively. Mean MRD1 was reduced by 1.4 mm (P < 0.001). Overall, 36 eyelids (29.5%) underwent revision surgery at 9.1 ± 9.2 months after implantation. Of those, 6 eyelids (5.0%) required 2 or more procedures. No platinum allergy occurred. The chain was graded as having no prominence in 77.5% of eyelids; the eyelids were graded as having a normal contour in 70.8% of cases.

CONCLUSIONS

Platinum segments are US Food and Drug Administration approved and provide benefits of platinum chains with the additional advantages of allowing postoperative adjustability, reduced health care costs, and less likelihood of inducing allergy than gold. Platinum segments are an ideal first-line loading implant for lagophthalmos.

Exploring Patient Experience of Facial Nerve Palsy to Inform the Development of a PROM

Background

There is currently a mandate globally to incorporate patient's perceptions of their illness into outcome measures, in order to provide a deeper insight into medical practice. Facial nerve palsy (FNP) is a devastating condition that can significantly impact quality of life. However, no measure currently exists that comprehensively assesses outcome in FNP using patient perception. The aim of this study is to explore patients' experiences of FNP with the aim of informing the development of a patient-reported outcome measure.

Methods

Presented is a qualitative study, using in-depth semi-structured interviews with FNP patients. An interview guide was developed using expert opinion and a literature review. Interpretative description was used as the qualitative approach. Interviews were audio-recorded, transcribed, and coded line-by-line. Codes were refined using the constant comparison approach. Interviews continued until data saturation was reached. The data were used to develop a conceptual framework of patient perceived issues relating to FNP.

Results

The sample included 5 men and 9 women aged 57.7 years (range, 36-78) with a range of causes of FNP, including Bell's palsy (n = 5), acoustic neuroma (n = 3), trauma (n = 2), meningioma (n = 1), muscular dystrophy (n = 1), congenital (n = 1), and Ramsay Hunt syndrome (n = 1). Analysis of the 14 participant interviews led to identification of 5 major domains including "facial function concerns," "appearance concerns," "psychological function," "social function," and "experience of care."

Conclusion

This study provides a conceptual framework covering outcomes that matter to patients with FNP, which can be used to inform the development of a new comprehensive FNP-specific patient-reported outcome measure.

Gold in the balance: How does patient posture affect eyelid closure?

A retrospective audit was conducted of four patients with upper eyelid gold weights (inserted >5 years ago) as treatment for facial nerve palsy-related lagophthalmos. Each patient was presently examined for lagophthalmos ("opened" or "closed") at three different patient inclinations (lying flat at 0º, lying back at 45º, and sitting upright at 90º). In all four cases at 0º inclination, the upper eyelid remained "open" with significant lagophthalmos, and therefore the ocular surface was vulnerable. At other inclinations, 45º and 90º, the eyes were substantially "closed" and the ocular surface was protected. We discuss the mechanism by which this occurs. We suggest that patients fitted with upper eyelid gold weight implant who do not show adequate closure during postoperative clinical examination or signs of corneal show should try sleeping in a slightly upright position to aid ocular surface protection.

Application of Palpebral Spring in Asian Patients With Paralytic Lagophthalmos

PURPOSE

Literature on palpebral springs is scarce, and even more so for the Asian population. In this study, the authors evaluated their experience with palpebral spring placement for paralytic lagophthalmos in an Asian population. The authors report the unique challenges encountered due to the distinctive features in Asian eyelids and how they overcome them. To the best of our knowledge, this is the first report on the application of palpebral springs in Asians.

METHODS

All patients treated for paralytic lagophthalmos in the Department of Surgery, Queen Mary Hospital, from November 2013 to December 2015, were included in this study. The authors retrieved and analyzed the demographic data, preoperative assessment details, and treatment outcomes.

RESULTS

A total of 17 patients were recruited. The median interval between facial palsy occurrence and surgery was 66 months. Preoperatively, vertical palpebral fissure was 12.3 ± 1.7 mm with margin reflex distance 1 of 3.7 ± 0.3 mm and margin reflex distance 2 of 8.6 ± 1.6 mm. Lagophthalmos before surgery was 9.6 ± 2.3 mm. After the palpebral spring surgeries, vertical palpebral fissure was reduced to 9.1 ± 1.4 mm. margin reflex distance 1 is slightly reduced (3.3 ± 0.8 mm) and margin reflex distance 2 improved to 5.8 ± 1.0 mm. Lagophthalmos reduced significantly to 0.8 ± 1.3 mm. Seven patients required revision procedures.

CONCLUSIONS

Palpebral spring is a safe and effective treatment for Asian patients with paralytic lagophthalmos. However, surgeons should be aware of the unique challenges associated with the anatomy of Asian eyelids. Special adaptation of the procedure is required to optimize the outcome.

[Rehabilitation of facial palsy and vertigo in patients with vestibular schwannoma]

BACKGROUND

Facial palsy and vertigo, as symptoms of vestibular schwannoma (VS) or consequences of its therapy, have a significant impact on patients' quality of life.

OBJECTIVE

This review analyzed current literature on the topic and deduced recommendations for rehabilitation of facial palsy and vertigo.

METHODS

The present review describes a PubMed-based search of the literature of the past 10 years.

RESULTS

There is no evidence-based drug therapy for the treatment of acute facial palsy after VS surgery. Several surgical procedures for facial nerve reconstruction, muscle transfer, and static techniques have been established. Physiotherapeutic movement therapy, optimally with biofeedback, seems to improve facial function in patients with post-paralytic syndrome. Botulinum toxin injections are the method of choice for synkinesis treatment. For treatment of acute and chronic vertigo in patients with VS, the same antivertiginous drugs as for other vertigo patients are used. If the patient shows retained vestibular stimulation function, preoperative intratympanic gentamycin therapy followed by compensation training is a promising approach to decreasing postoperative vertigo. Good vestibular rehabilitation comprises intensive and regular movement training, preferably with real-time feedback and therapy control.

CONCLUSION

There are several conservative, surgical, or combined conservative-surgical treatment options for individualized facial nerve rehabilitation of VS patients, as confirmed by clinical studies. In cases of acute vertigo, standard antivertiginous pharmacotherapy is indicated. In cases of acute and also of chronic vertigo, intensive balance and movement training relieves complaints.

Surgical rehabilitation of paralytic lagophthalmus by platinum chain lid loading: focusing on patient benefit and health-related quality of life

OBJECTIVE

To evaluate patient benefit and health-related quality of life after lid loading with platinum chains in adult patients with facial palsy.

STUDY DESIGN

Retrospective data collection.

SETTING

Germany's largest university clinic for otorhinolaryngology, head and neck surgery.

SUBJECTS AND METHODS

Thirty-five patients received validated questionnaires determining the effects of the operation on the patients' health-related quality of life (Glasgow Benefit Inventory). Scores can range from -100 (maximal adverse effect), through 0 (no effect), to 100 (maximal positive effect). Furthermore, satisfaction, complaints, and complications regarding the platinum chain implant were inquired.

RESULTS

Twenty-two patients (63 %) returned a valid questionnaire. The mean follow-up time was 31.5 months. A complete coverage of the cornea was achieved in 95% of the patients after the first operation and in the remaining patients after a revision with implantation of a heavier weight. Complete symmetry to the nonaffected eye was perceived by 64%. Recurrent conjunctivitis was complained preoperatively by 18% and postoperatively only by a single patient. In 2 patients, a mild pseudoptosis was found postoperatively, and a single patient complained about blurred vision. The median total Glasgow Benefit Inventory score was 27.8 (p < 0.001). The health-related quality of life was raised in 91% of the patients; 87% were fully satisfied with the functional result, and 91% with the aesthetical result. 100% would again decide in favor of platinum chain lid loading.

CONCLUSION

Platinum chain lid loading in facial palsy patients can significantly increase patients' health-related quality of life and leads to a high rate of patient satisfaction.

Modern concepts in facial nerve reconstruction

Background

Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons. The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques. On this background it is worthwhile to develop a standardized approach for diagnosis and treatment of patients asking for facial rehabilitation.

Conclusion

A standardized approach is feasible: Patients with chronic facial palsy first need an exact classification of the palsy's aetiology. A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy, an individual surgical concept is applicable using three main approaches: a) early extratemporal reconstruction, b) early reconstruction of proximal lesions if extratemporal reconstruction is not possible, c) late reconstruction or in cases of congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardized evaluation of the therapeutic results is recommended to evaluate the necessity for adjuvant surgical procedures or other adjuvant procedures, e.g. botulinum toxin application. Up to now controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies.