Unilateral peripheral facial paralysis following vestibular schwannoma surgical removal: early evaluation of eating and drinking ability. A pilot study

Abstract

Introduction: Unilateral peripheral facial palsy after vestibular neuroma surgery may cause miming, articulatory, communication and swallowing disorders, especially with liquids. The therapy ranges from no intervention to intensive treatment directly following onset or after a resting period of several months, when the nerve shows signs of recovery.Methods: The study is divided in two sequential steps. Patients involved in the first phase can volunteer for the second phase. In the first phase the perceived impairment was measured through a self-assessment questionnaire, the ‘Facial Disability Index’ (FDI). Other five questions were added to the FDI to better understand the perceived impairment of oral functions. In this second phase of the study, three clinical follow-ups were conducted by two Speech and Language Therapists during a 3-months period. During each session the Sunnybrook Facial Grading System (SFGS) Scale was used to assess the severity of facial palsy in terms of facial asymmetry at rest or in motion and presence of synkinesis. Each evaluation was recorded on videotape and scored. Moreover, patients were monitored and observed during the ingestion of solid and liquid foods to detect difficulties and compensatory behaviours.Results: The median values and interquartile ranges for Physical, Social and Oral functioning scales of the FDI questionnaire were 48 [40–52], 76 [72–80], 52 [32–56] respectively. The Physical scale seemed to be the most impaired, the Oral functioning is the one with the lower scores. Four patients of the first phase entered the second one. During the follow-ups, they all showed a reduction of the perceived impairment although there was no significant physical recovery, as the SFGS remain stable.Discussion: The study supports the importance of the FDI, as a disease-specific, self-report functional status instrument. The follow-ups seem to confirm that the severity of dysphagia and swallowing disorder does not correlate with the severity of the facial palsy. The present study suggests adding patient’s education to the first rehabilitation goals, to allow the patient to have a better understanding of his/her oral functioning, that is altered after surgery.