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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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Telich-Tarriba JE, Navarro-Barquin DF, Pineda-Aldana G, Cardenas-Mejia A. Triple nerve transfers for the management of early unilateral facial palsy. J Plast Surg Hand Surg 2023; 58:62-66. [PMID: 37554097 DOI: 10.2340/jphs.v58.6527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/02/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Early onset facial paralysis is usually managed with cross-face nerve grafts, however the low number of axons that reach the target muscle may result in weakness or failure. Multiple-source innervation, or 'supercharging', seeks to combine the advantages of different donor nerves while minimizing their weaknesses. We propose a combination of cross-face nerve grafts with local extra-facial nerve transfers to achieve earlier facial reanimation in our patients. METHODS A retrospective cohort including all patients with early unilateral facial palsy (<12 months evolution) who underwent triple nerve transfer between 2019 and 2021 was conducted. We performed single-stage procedure including zygomatic-to-zygomatic and buccal-to-buccal cross-face grafts, a nerve-to-masseter to bucozygomatic trunk transfer, and a mini-hypoglossal to marginal branch transfer. Results were evaluated using the clinician-graded facial function scale (eFACE). RESULTS Fifteen patients were included (eight females, seven males), mean age at the time of surgery was 48.9 ± 13.3 years. Palsy was right-sided in eight cases. The mean time from palsy onset to surgery was 5.5 ± 2.8 months. Patients showed improvement in static (70.8 ± 21.9 vs. 84.15 ± 6.68, p = 0.002) and dynamic scores (20 ± 16.32 vs. 74.23 ± 7.46, p < 0.001), as well as periocular (57.33 ± 15.23 vs. 74 ± 7.18, p = 0.007), smile (54.73 ± 11.93 vs. 85.62 ± 3.86, p < 0.001), mid-face (46.33 ± 18.04 vs. 95 ± 7.21, p < 0.001) and lower face scores (67.4 ± 1.55 vs. 90.31 ± 7.54, p < 0.001). CONCLUSION The triple nerve transfer technique using cross-face nerve grafts, the nerve-to-masseter, and the hypoglossal nerve, is an effective and reproducible technique to obtain middle and lower face reanimation in cases of early facial palsy.
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Affiliation(s)
- Jose E Telich-Tarriba
- Plastic and Reconstructive Surgery Division, Hospital General 'Dr. Manuel Gea Gonzalez', Mexico City, Mexico; Plastic Surgery Department, Hospital Angeles Pedregal, Mexico City, Mexico.
| | - David F Navarro-Barquin
- Plastic and Reconstructive Surgery Division, Hospital General 'Dr. Manuel Gea Gonzalez', Mexico City, Mexico
| | - Genesis Pineda-Aldana
- Plastic and Reconstructive Surgery Division, Hospital General 'Dr. Manuel Gea Gonzalez', Mexico City, Mexico
| | - Alexander Cardenas-Mejia
- Plastic and Reconstructive Surgery Division, Hospital General 'Dr. Manuel Gea Gonzalez', Mexico City, Mexico
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Gaber A, Taher MF, Abdel Wahed M, Shalaby NM, Gaber S. Comprehensive assessment of facial paralysis based on facial animation units. PLoS One 2022; 17:e0277297. [PMID: 36516130 PMCID: PMC9750034 DOI: 10.1371/journal.pone.0277297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022] Open
Abstract
Quantitative grading and classification of the severity of facial paralysis (FP) are important for selecting the treatment plan and detecting subtle improvement that cannot be detected clinically. To date, none of the available FP grading systems have gained widespread clinical acceptance. The work presented here describes the development and testing of a system for FP grading and assessment which is part of a comprehensive evaluation system for FP. The system is based on the Kinect v2 hardware and the accompanying software SDK 2.0 in extracting the real time facial landmarks and facial animation units (FAUs). The aim of this paper is to describe the development and testing of the FP assessment phase (first phase) of a larger comprehensive evaluation system of FP. The system includes two phases; FP assessment and FP classification. A dataset of 375 records from 13 unilateral FP patients was compiled for this study. The FP assessment includes three separate modules. One module is the symmetry assessment of both facial sides at rest and while performing five voluntary facial movements. Another module is responsible for recognizing the facial movements. The last module assesses the performance of each facial movement for both sides of the face depending on the involved FAUs. The study validates that the FAUs captured using the Kinect sensor can be processed and used to develop an effective tool for the automatic evaluation of FP. The developed FP grading system provides a detailed quantitative report and has significant advantages over the existing grading scales. It is fast, easy to use, user-independent, low cost, quantitative, and automated and hence it is suitable to be used as a clinical tool.
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Affiliation(s)
- Amira Gaber
- Faculty of Engineering, Systems and Biomedical Engineering Department, Cairo University, Giza, Egypt
| | - Mona F Taher
- Faculty of Engineering, Systems and Biomedical Engineering Department, Cairo University, Giza, Egypt
| | - Manal Abdel Wahed
- Faculty of Engineering, Systems and Biomedical Engineering Department, Cairo University, Giza, Egypt
| | | | - Sarah Gaber
- Faculty of Physical Therapy, Department of Neuromuscular Disorder and Its Surgery, Cairo University, Giza, Egypt
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Jančić J, Zeković J, Ćetković M, Nikolić B, Ivančević N, Vučević D, Nešić Z, Milovanović S, Radenković M, Samardžić J. Acute Peripheral Facial Nerve Palsy in Children and Adolescents: Clinical Aspects and Treatment Modalities. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 22:CNSNDDT-EPUB-126028. [PMID: 36045521 DOI: 10.2174/1871527321666220831095204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Peripheral facial nerve palsy is a relatively frequent, rather idiopathic, and isolated nonprogressive disorder with a tendency toward spontaneous recovery in children. It is primarily characterized by unilateral paresis or paralysis of the mimic musculature affecting verbal communication, social interactions, and quality of life. OBJECTIVE This study aimed to evaluate the clinical aspects and efficacy of different therapeutic modalities in the population of children and adolescents with acute peripheral facial nerve palsy, the quality and recovery rate in comparison to different therapy modalities and etiological factors as well as to determine parameters of recovery according to the age of patients. METHODS The retrospective study included children and adolescents (n=129) with an acute onset of peripheral facial nerve palsy, diagnosed and treated in the Clinic of Neurology and Psychiatry for Children and Youth in Belgrade (2000-2018). The mean age of the patients was 11.53 years (SD±4.41). Gender distribution: 56.6% female and 43.4% male patients. RESULTS There were 118 (91.5%) patients with partial and 11 (8.5%) patients with complete paralysis. Left-sided palsy occurred in 67 (51.9%) patients, right-sided in 58 (45.0%), while there were 4 (3.1%) bilateral paralyses. The most common etiological factor was idiopathic (Bell's palsy) - 74 (57.4%) patients followed by middle ear infections - 16 (12.4%). Regardless of etiology, age, and therapy protocols, there was a significant recovery in most of the patients (p<0.001), without significant differences in recovery rate. Comparison of inpatient and outpatient populations showed significant differences regarding the number of relapses, severity of clinical presentation, and recovery rate in relation to etiology. CONCLUSION Bell's palsy is shown to be the most common cause of peripheral facial nerve palsy in children and adolescents, regardless of gender. It is followed by mid-ear infections, respiratory infections, and exposure to cold. Most children and adolescents recovered in three weeks after initial presentation, regardless of etiology, age, and therapy.
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Affiliation(s)
- Jasna Jančić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Janko Zeković
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Mila Ćetković
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, Serbia
| | - Blažo Nikolić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Nikola Ivančević
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Danijela Vučević
- Institute of Pathophysiology \\\'Ljubodrag Buba Mihailovic\\\', Faculty of Medicine, University of Belgrade, Serbia
| | - Zorica Nešić
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Srđan Milovanović
- Clinic of Psychiatry, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Miroslav Radenković
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Janko Samardžić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
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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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Jeong J, Lee JM, Cho YS, Kim J. Inter-rater discrepancy of the House-Brackmann facial nerve grading system. Clin Otolaryngol 2022; 47:680-683. [PMID: 35818896 DOI: 10.1111/coa.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/31/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jeon Mi Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Liang L, Qiang F. Observation on the Clinical Effect of Acupuncture and Moxibustion Combined with Repeated Transcranial Magnetic Stimulation on Facial Paralysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:9642677. [PMID: 34777570 PMCID: PMC8589486 DOI: 10.1155/2021/9642677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
In view of the difficulty in the treatment of facial paralysis and the poor effect of traditional methods, this paper proposes a strategy based on acupuncture and repeated transcranial magnetic stimulation. The three groups of patients were tested for efficacy using the H-B scale and the symptom characteristics and physical signs measurement scale. Acupuncture combined with repetitive transcranial magnetic stimulation can improve the clinical efficacy of facial paralysis. And it is significantly better than traditional paralysis and repetitive translational magnetic stimulation in the degree of healing.
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Affiliation(s)
- Lina Liang
- Department of Rehabilitation Medicine, Xianyang Hospital of University, Xianyang, 712000 Shaanxi, China
| | - Feng Qiang
- Department of Rehabilitation Medicine, Xianyang Hospital of University, Xianyang, 712000 Shaanxi, China
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Bruins TE, van Veen MM, Werker PMN, Dijkstra PU, Broekstra DC. Associations Between Clinician-Graded Facial Function and Patient-Reported Quality of Life in Adults With Peripheral Facial Palsy: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:717-728. [PMID: 34196663 DOI: 10.1001/jamaoto.2021.1290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Understanding how the quality of life of adults (≥18 years) with peripheral facial palsy can be estimated using clinician measures of facial function and patient-reported variables might aid in counseling patients and in conducting research. Objectives To analyze associations between clinician-graded facial function and patient-reported quality of life in adults with peripheral facial palsy, compare associations between facial function and the physical and social functions of quality of life, and examine factors that might influence the associations. Data Sources A literature search was conducted in PubMed, Embase, CINAHL, Web of Science and PsycInfo on June 4, 2020, with no restrictions on the start date. Study Selection Twenty-three studies reporting an association between clinician-graded facial function and patient-reported quality of life in adults with peripheral facial palsy were included. Facial function instruments included the House-Brackmann, Sunnybrook Facial Grading System, and electronic clinician-graded facial function assessment. Quality-of-life instruments included the Facial Disability Index and Facial Clinimetric Evaluation Scale. Data Extraction and Synthesis Data extraction and qualitative synthesis were performed according to the Meta-analysis of Observational Studies in Epidemiology guidelines. Record screening, data extraction, and quality assessments were done by 2 researchers independently. Data were pooled using random-effects models. Main Outcomes and Measures The main outcome was the association between facial function and quality of life, quantified by Pearson r, Spearman ρ, or regression analysis. Results In total, 23 studies (3746 participants) were included. In the 21 studies that reported on the sex of the cohorts, there were 2073 women (57.3%). Mean or median age ranged from 21 to 64 years and mean or median duration of palsy ranged from newly diagnosed to 12 years. Bell palsy (n = 1397), benign tumor (n = 980), and infection (n = 257) were the most common etiologic factors. Pooled correlation coefficients were 0.424 (95% CI, 0.375-0.471) to 0.533 (95% CI, 0.447-0.610) between facial function and Facial Clinimetric Evaluation Scale total, 0.324 (95% CI, 0.128-0.495) to 0.397 (95% CI, 0.242-0.532) between facial function and Facial Clinimetric Evaluation Scale social function, 0.423 (95% CI, 0.322-0.514) to 0.605 (95% CI, -0.124-0.910) between facial function and Facial Disability Index physical function, and 0.166 (95% CI, 0.044-0.283) to 0.208 (95% CI, 0.031-0.373) between facial function and Facial Disability Index social function. Conclusions and Relevance Associations noted in this systematic review and meta-analysis were overall low to moderate, suggesting that only a small part of quality of life is explained by facial function. Associations were higher between facial function and physical function than social function of quality of life.
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Affiliation(s)
- Tessa E Bruins
- University of Groningen, Department of Plastic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Martinus M van Veen
- University of Groningen, Department of Plastic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul M N Werker
- University of Groningen, Department of Plastic Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Pieter U Dijkstra
- University of Groningen, Center for Rehabilitation, Groningen, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Dieuwke C Broekstra
- University of Groningen, Department of Plastic Surgery, University Medical Center Groningen, Groningen, the Netherlands
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Computerized Sunnybrook facial grading scale (SBface) application for facial paralysis evaluation. Arch Plast Surg 2021; 48:269-277. [PMID: 34024071 PMCID: PMC8143948 DOI: 10.5999/aps.2020.01844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/24/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The Sunnybrook facial grading scale is a comprehensive scale for the evaluation of facial paralysis patients. Its results greatly depend on subjective input. This study aimed to develop and validate an automated Sunnybrook facial grading scale (SBface) to more objectively assess disfigurement due to facial paralysis. METHODS An application compatible with iOS version 11.0 and up was developed. The software automatically detected facial features in standardized photographs and generated scores following the Sunnybrook facial grading scale. Photographic data from 30 unilateral facial paralysis patients were randomly sampled for validation. Intrarater reliability was tested by conducting two identical tests at a 2-week interval. Interrater reliability was tested between the software and three facial nerve clinicians. RESULTS A beta version of the SBface application was tested. Intrarater reliability showed excellent congruence between the two tests. Moderate to strong positive correlations were found between the software and an otolaryngologist, including the total scores of the three individual software domains and composite scores. However, 74.4% (29/39) of the subdomain items showed low to zero correlation with the human raters (κ<0.2). The correlations between the human raters showed good congruence for most of the total and composite scores, with 10.3% (4/39) of the subdomain items failing to correspond (κ<0.2). CONCLUSIONS The SBface application is efficient and accurate for evaluating the degree of facial paralysis based on the Sunnybrook facial grading scale. However, correlations of the software-derived results with those of human raters are limited by the software algorithm and the raters' inconsistency.
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e-Health and telemedicine implementation in facial paralysis: challenges and pitfalls. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021; 44:429-434. [PMID: 33612973 PMCID: PMC7881343 DOI: 10.1007/s00238-021-01802-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/02/2021] [Indexed: 11/02/2022]
Abstract
During the current Covid-19 pandemic, a lot of changes had to be made in the care of patients with facial nerve paralysis (FNP). FNP is a life-changing condition with effects on both physical (both esthetic and functional) and psychological aspects of the patient's life. Telemedicine could be a suitable alternative in the therapy for these patients, since it is often not possible to travel to outpatient clinics or to have normal face-to-face appointments with treating physicians because of pandemic restrictions. This review provides an overview of the current literature in the treatment of FNP during the pandemic and the role of telemedicine/e-Health. Secondly, we will discuss the challenges and pitfalls of implementing e-Health and telemedicine applications in clinical practice. Level of evidence: Not ratable.
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Vaughan A, Gardner D, Miles A, Copley A, Wenke R, Coulson S. A Systematic Review of Physical Rehabilitation of Facial Palsy. Front Neurol 2020; 11:222. [PMID: 32296385 PMCID: PMC7136559 DOI: 10.3389/fneur.2020.00222] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Facial palsy is a frequent and debilitating sequela of stroke and brain injury, causing functional and aesthetic deficits as well as significant adverse effects on quality of life and well-being. Current literature reports many cases of acquired facial palsy that do not recover spontaneously, and more information is needed regarding the efficacy of physical therapies used in this population. Methods: A systematic search of eight electronic databases was performed from database inception to December 2018. Gray literature searches were then performed to identify additional articles. Studies were included if they addressed physical rehabilitation interventions for adults with acquired facial palsy. Reasons for exclusion were documented. Independent data extraction, quality assessment, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Following abstract screening, a total of 13 full-text articles were identified for independent screening by two reviewers. This included four randomized control trials, two non-randomized control trials, one cohort study, and six prospective case series studies. Twelve out of the 13 included studies reported on facial palsy as a sequela of stroke. A total of 539 participants received intervention for facial palsy across the 13 included studies. Therapy design, length and frequency of intervention varied across the studies, and a wide range of outcome measures were used. Improvement on various outcome measures was reported across all 13 studies. The quality of the evidence was low overall, and most studies were found to have high risk of bias. Conclusions: All the studies in this review report improvement of facial movement or function following application of various methods of physical rehabilitation for facial palsy. Methodological limitations and heterogeneity of design affect the strength of the evidence and prevent reliable comparison between intervention methods. Strong evidence supporting physical rehabilitation was not found; well-designed rigorous research is required.
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Affiliation(s)
- Annabelle Vaughan
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Danielle Gardner
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Anna Miles
- Speech Science, The University of Auckland, Auckland, New Zealand
| | - Anna Copley
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Rachel Wenke
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Susan Coulson
- School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Camperdown, NSW, Australia
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Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following Radical Parotidectomy. Plast Reconstr Surg 2020; 144:853e-863e. [PMID: 31688764 DOI: 10.1097/prs.0000000000006183] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors' experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy. METHODS A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database. The return of dynamic midface movement was the primary outcome investigated. Electronic, clinician-graded facial function scale grades were used to formally assess postoperative outcomes. RESULTS A total of 27 patients were included in the study with an average age of 72 years (range, 31 to 88 years). Thirteen patients (48 percent) had developed dynamic function by the end of the study period. Young age predicted a more rapid return to dynamic function (p = 0.018). Both being a woman and having an intact facial nerve before surgery improved dynamic midface movement (p = 0.005 and p = 0.036, respectively). On multivariable analysis, superior midface dynamic function was associated with neurotization using midface facial nerve branches as opposed to using nerve-to-masseter alone (p = 0.05). CONCLUSION The chimeric vastus lateralis and anterolateral thigh flap is a suitable option for restoring defects and dynamic function following radical parotidectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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van Veen MM, Tavares-Brito J, van Veen BM, Dusseldorp JR, Werker PMN, Dijkstra PU, Hadlock TA. Association of Regional Facial Dysfunction With Facial Palsy-Related Quality of Life. JAMA FACIAL PLAST SU 2020; 21:32-37. [PMID: 30073264 DOI: 10.1001/jamafacial.2018.0804] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Study of the association of regional facial dysfunction with quality of life will lead to a better understanding of quality of life in facial palsy. Objective To determine the association of regional facial dysfunction with facial palsy-related quality of life. Design, Setting, and Participants This retrospective cohort analysis included patients with flaccid and nonflaccid (synkinetic) facial palsy treated at a tertiary care facial nerve center; the flaccid facial palsy group included 529 patients, and the nonflaccid facial palsy group included 391 patients. Data were included from all patients with facial palsy who had an eFACE score and Facial Clinimetric Evaluation (FaCE) scale total score acquired at the same time from February 1, 2014, through October 31, 2017. Linear regression analysis was performed to calculate the amount of variance in quality of life explained by the severity of facial palsy (eFACE). A relative weight analysis was performed for the contribution of each individual eFACE item in estimating quality of life. Main Outcomes and Measures Facial palsy severity was measured using all 15 individual eFACE items (rated on a scale of 0 to 200, where 0 represents complete flaccidity, 100 represents a balanced aesthetic appearance, and 200 represents the worst imaginable hypertonia of a patient with synkinesis, with a transformation used for values from 101 to 200), and facial palsy-related quality of life was measured using the FaCE scale total score (range, 0 [worst] to 100 [best]). Results Data of 920 individual patients (59.5% female; mean [SD] age, 48.6 [16.6] years) were available. The eFACE composite score accounted for 21.2% of the quality-of-life variance in the flaccid group and 13.9% in the nonflaccid group. With the use of all 15 individual eFACE items, these proportions increased to 29.7% and 16.8%, respectively. In both groups, oral commissure movement with smile was found to be the most important contributing item (relative weight, 0.108 [95% CI, 0.075-0.148] for the flaccid group and 0.025 [95% CI, 0.005-0.052] for the nonflaccid group). Items related to the function of periocular muscles were found to be of low importance. Conclusions and Relevance The present study suggests that the function of individual facial regions is not equally important for estimating facial palsy-related quality of life. The ability to smile is of greatest importance among patients with flaccid and nonflaccid facial palsy. The true importance of periocular function in the estimation of quality of life should be studied further in future research. Level of Evidence NA.
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Affiliation(s)
- Martinus M van Veen
- Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.,Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joana Tavares-Brito
- Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Britt M van Veen
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, the Netherlands
| | - Joseph R Dusseldorp
- Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.,Department of Plastic and Reconstructive Surgery, Royal Australasian College of Surgeons, University of Sydney, Sydney, Australia
| | - Paul M N Werker
- Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tessa A Hadlock
- Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Tan JR, Coulson S, Keep M. Face-to-Face Versus Video Assessment of Facial Paralysis: Implications for Telemedicine. J Med Internet Res 2019; 21:e11109. [PMID: 30977734 PMCID: PMC6484264 DOI: 10.2196/11109] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with facial nerve paralysis (FNP) experience challenges in accessing health care that could potentially be overcome by telemedicine. However, the reliability of telemedicine has yet to be established in this field. OBJECTIVE This study aimed to investigate the consistency between face-to-face and video assessments of patients with FNP by experienced clinicians. METHODS A repeated-measures design was used. A total of 7 clinicians assessed the FNP of 28 patients in a face-to-face clinic using standardized grading systems (the House-Brackmann, Sydney, and Sunnybrook facial grading systems). After 3 months, the same grading systems were used to assess facial palsy in video recordings of the same patients. RESULTS The House-Brackmann system in video assessment had excellent reliability and agreement (intraclass correlation coefficient [ICC]=0.780; principal component analysis [PCA]=87.5%), similar to face-to-face assessment (ICC=0.686; PCA=79.2%). Reliability of the Sydney system was good to excellent, with excellent agreement face-to-face (ICC=0.633 to 0.834; PCA=81.0%-95.2%). However, video assessment of the cervical branch and synkinesis had fair reliability and good agreement (ICC=0.437 to 0.597; PCA=71.4%), whereas that of other branches had good to excellent reliability and excellent agreement (ICC=0.625 to 0.862; PCA=85.7%-100.0%). Reliability of the Sunnybrook system was poor to fair for resting symmetry (ICC=0.195 to 0.498; PCA=91.3%-100.0%) and synkinesis (ICC=-0.037 to 0.637; PCA=69.6%-87.0%) but was good to excellent for voluntary movement (ICC=0.601 to 0.906; PCA=56.5%-91.3%) in face-to-face and video assessments. Bland-Altman plots indicated normal limits of agreement within ±1 between face-to-face and video-assessed scores only for the temporal and buccal branches of the Sydney system and for resting symmetry in the Sunnybrook system. CONCLUSIONS Video assessment of FNP with the House-Brackmann and Sunnybrook systems was as reliable as face-to-face but with insufficient agreement, especially in the assessment of synkinesis. However, video assessment does not account for the impact of real-time interactions that occur during tele-assessment sessions.
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Affiliation(s)
- Jian Rong Tan
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Susan Coulson
- Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Melanie Keep
- Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
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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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Validation of the Clinician-Graded Electronic Facial Paralysis Assessment. Plast Reconstr Surg 2018; 141:614e-615e. [PMID: 29596203 DOI: 10.1097/prs.0000000000004221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reply: Validation of the Clinician-Graded Electronic Facial Paralysis Assessment. Plast Reconstr Surg 2018; 141:615e-616e. [PMID: 29596204 DOI: 10.1097/prs.0000000000004222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thevenot J, Lopez MB, Hadid A. A Survey on Computer Vision for Assistive Medical Diagnosis From Faces. IEEE J Biomed Health Inform 2017; 22:1497-1511. [PMID: 28991753 DOI: 10.1109/jbhi.2017.2754861] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Automatic medical diagnosis is an emerging center of interest in computer vision as it provides unobtrusive objective information on a patient's condition. The face, as a mirror of health status, can reveal symptomatic indications of specific diseases. Thus, the detection of facial abnormalities or atypical features is at upmost importance when it comes to medical diagnostics. This survey aims to give an overview of the recent developments in medical diagnostics from facial images based on computer vision methods. Various approaches have been considered to assess facial symptoms and to eventually provide further help to the practitioners. However, the developed tools are still seldom used in clinical practice, since their reliability is still a concern due to the lack of clinical validation of the methodologies and their inadequate applicability. Nonetheless, efforts are being made to provide robust solutions suitable for healthcare environments, by dealing with practical issues such as real-time assessment or patients positioning. This survey provides an updated collection of the most relevant and innovative solutions in facial images analysis. The findings show that with the help of computer vision methods, over 30 medical conditions can be preliminarily diagnosed from the automatic detection of some of their symptoms. Furthermore, future perspectives, such as the need for interdisciplinary collaboration and collecting publicly available databases, are highlighted.
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