Assessment Of Facial Function Research Articles

The assessment of facial nerve function

The assessment of facial nerve function plays a crucial role in the diagnosis and treatment of facial nerve disorders.The assessment system for facial nerve function is primarily categorized into subjective and objective systems.While the subjective assessment system is relatively simple, it lacks accuracy as it can be influenced by the subjectivity of evaluator.Whereas, the objective system offers higher precision and stability, providing more quantitative information. In recent years, benefited with advancements in computer vision and artificial intelligence,we have witnessed increasingly accurate,stable and intelligent facial nerve assessment systems gradually implemented in clinical practice.When selecting a specific facial nerve assessment system,factors such as clinical scenarios,assessment objectives,patient characteristics should be considered.

Assessment of Facial Function in Patients with Facial Palsy Using Patient-Based and Clinician-Based Tools

Facial palsy is a serious disorder that impairs both function and appearance resulting from facial muscle weakness. It impairs the quality of life of affected patients. There are questionnaires for general health and disease-specific assessments of quality of life accessible. Objective: To assess the facial function in patients with facial palsy using patient-based and clinician-based tools. Methods: A cross-sectional study was conducted among patient diagnosed with facial palsy. The study sample size 79 of both genders calculated via Epitools software and using convenient sampling technique. A pre-tested structured valid and reliable tool was used for the assessment of disability and facial function via Facial Clinimetric Evaluation used as patient-based tool and House-Brackmann Scoring Scale used as clinical based tool. SPSS version 25.0 was used to analyze data. Results: The mean age of the participants was 27.53 years. 59.5% were males whereas, 40.5% were females. So, a higher prevalence of males was seen. 58.2% were recorded at grade IV (moderately severe), 31.6% were at grade III (moderate level) and 10.1% were at grade V (severe) level. There was statistically significant association between House-Brackmann scores and facial clinimetric evaluation scores (p<0.001) that was indicating that there was an association between disability and patient’s perception towards facial palsy. Conclusions: Facial Clinimetric Evaluation scale used as patient-based tool provide subjective experience and functional limitation experienced by facial palsy patient while House-Brackmann Scoring Scale used as clinical based tool provides objective evaluation of facial function of facial palsy patient.

Post-parotidectomy facial nerve function: comparison between original and modified Sunnybrook Facial Grading Systems.

Facial nerve dysfunction is the principal postoperative complication related to parotidectomy. To test the hypothesis that the modified Sunnybrook Facial Grading System (mS-FGS) is superior to the original S-FGS in the assessment of facial nerve function following parotidectomy. Prospective, longitudinal study evaluating patients with primary or metastatic parotid neoplasms undergoing parotidectomy with facial nerve-sparing between 2016 and 2020. The subjects were assessed twice, on the first postoperative day and at the first outpatient evaluation, 20-30 days post-surgery. Facial assessments were performed using the original and modified (plus showing the lower teeth) versions of the Sunnybrook System and documented by pictures and video recordings. Intra- and inter-rater agreements regarding the assessment of the new expression were analyzed. 101 patients were enrolled. In both steps, the results from the mS-FGS were significantly lower (p < 0.001). Subjects with a history of previous parotidectomy and those who underwent neck dissection had more severe facial nerve impairment. The mandibular marginal branch was the most frequently injured, affecting 68.3% of the patients on the first postoperative day and 52.5% on the first outpatient evaluation. Twenty patients (19.8%) presented an exclusive marginal mandibular branch lesion. The inter-rater agreement of the new expression assessment ranged from substantial to almost perfect. The intra-rater agreement was almost perfect (wk = 0.951). The adoption of the Modified Sunnybrook System, which includes evaluation of the mandibular marginal branch, increases the accuracy of post-parotidectomy facial nerve dysfunction appraisal.

Validation of the Spanish version of the Electronic Facial Palsy Assessment (eFACE)

PurposeThe 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.MethodsForward–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).ResultsThe 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).ConclusionThe 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.

Validationof the Spanish version of the Sunnybrook facial grading system.

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. 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. 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. 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.

Associations Between Clinician-Graded Facial Function and Patient-Reported Quality of Life in Adults With Peripheral Facial Palsy

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. 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. 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. 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 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. The main outcome was the association between facial function and quality of life, quantified by Pearson r, Spearman ρ, or regression analysis. 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. 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.

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.

Toward an Automatic System for Computer-Aided Assessment in Facial Palsy.

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.

Clinician and Automated Assessments of Facial Function Following Eyelid Weight Placement.

Quantitative assessment of facial function is difficult, and historic grading scales such as House-Brackmann have well-recognized limitations. The electronic, clinician-graded facial function scale (eFACE) allows rapid regional analysis of static, dynamic, and synkinetic facial function in patients with unilateral facial palsy within the course of a clinical encounter, but it relies on clinician assessment. A newly developed, machine-learning algorithm (Emotrics) provides automated, objective facial measurements but lacks clinical input (ie, recognizing laterality of facial palsy or synkinesis). To compare the sensitivity of a clinician-based tool (eFACE) to a well-established intervention for facial palsy (eyelid weight placement) with an automated facial-measurement algorithm (Emotrics). A retrospective review was conducted of the most recent 53 patients with unilateral facial palsy who received an eyelid weight at the Massachusetts Eye and Ear Infirmary Facial Nerve Center from 2014 to 2017. Preoperative and postoperative photographs were deidentified and randomized. The entire cohort was analyzed by 3 clinicians, as well as by the Emotrics program. eFACE scores of the palpebral fissure at rest (0, wide; 100, balanced; 200, narrow), with gentle eyelid closure (0, incomplete; 100, complete), and with forceful eyelid closure (0, incomplete; 100, complete) before and after eyelid weight placement were compared with palpebral fissure measurements by Emotrics. Of the 53 participants, 33 were women, and mean (SD) age was 44.7 (18) years. The mean (SD) eFACE scores and Emotrics measurements (in millimeters) before vs after eyelid weight placement of the palpebral fissure at rest (eFACE, 84.3 [15.9] vs 109.7 [21.4]; Emotrics, 10.3 [2.2] vs 9.1 [1.8]), with gentle eyelid closure (eFACE, 65.9 [28.0] vs 92.1 [15.4]; Emotrics, 4.4 [2.7] vs 1.3 [2.0]), and with forceful eyelid closure (eFACE, 75.1 [28.6] vs 97.0 [10.7]; Emotrics, 3.0 [3.1] vs 0.5 [1.3]) all significantly improved. Subgroup analysis of patients with expected recovery (eg, Bell palsy) (n = 40) demonstrated significant development of ocular synkinesis on eFACE (83.9 [22.7] vs 98.9 [4.4]) after weight placement, which could also explain the improvement in eyelid function. The scores of patients with no expected recovery (n = 13) improved in both eFACE and Emotrics analysis following eyelid weight placement, though results did not reach significance, likely limited by the small subgroup size. The eFACE tool agrees well with automated, objective facial measurements using a machine-learning based algorithm such as Emotrics. The eFACE tool is sensitive to spontaneous recovery and surgical intervention, and may be used for rapid regional facial function assessment from a clinician's perspective following recovery and/or surgical intervention. 4.

Functional results after facial reanimation in iatrogenic facial palsy.

Iatrogenic facial nerve injury is a common cause of long-standing facial palsy. This study aimed to assess functional results after facial reanimation in iatrogenic facial palsy and to determine correlating patient factors. The data of 128 iatrogenic facial palsy patients were analyzed for this case series. Inclusion criteria for assessment of facial function by three-dimensional video analysis were preoperative and postoperative (>18 months) video sets for facial marker tracking, which were available in 63 patients. Demographic factors and treatment concepts were analyzed and correlations to functional outcomes calculated. One hundred and twenty-eight patients with iatrogenic facial palsy underwent facial reanimation procedures and were included in this study. The mean duration of facial palsy was 7.8 years. The most common procedures leading to iatrogenic facial palsy were acoustic neuroma resection (29.7%), parotidectomy (21.1%), and brainstem/cerebellopontine angle tumor resection (21.1%). Selected functional results were significantly improved after facial reanimation surgery. The mean lagophthalmos during eyelid closure reduced from 7.3 ± 4.1 mm to 5.4 ± 4 mm (p < .001). The function of the mouth was significantly improved, both statically (static asymmetry: 10.3 ± 7.6 mm preoperatively, 0.8 ± 9.5 mm postoperatively; p < .001), and during smile movement ("Dynamic Symmetry Index": 0.16 preoperatively, 0.39 postoperatively; p < .001). The mean duration of facial palsy correlated with postoperative smiling function (r = .358, p = .011). Facial reanimation significantly improves facial function in iatrogenic facial palsy. Early referral to a facial nerve center is crucial as duration of facial palsy influences functional outcomes.

A Machine Learning Approach for Automated Facial Measurements in Facial Palsy

JAMA Facial Plastic SurgeryVol. 20, No. 4 ObservationA Machine Learning Approach for Automated Facial Measurements in Facial PalsyDiego L. Guarin, Joseph Dusseldorp, Tessa A. Hadlock, and Nate JowettDiego L. GuarinCorresponding Author: Diego L. Guarin, PhD, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114 E-mail Address: diego_guarin@meei.harvard.eduDepartment of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, CambridgeSearch for more papers by this author, Joseph DusseldorpDepartment of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, CambridgeUniversity of Sydney, Sydney, AustraliaSearch for more papers by this author, Tessa A. HadlockDepartment of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, CambridgeSearch for more papers by this author, and Nate JowettDepartment of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, CambridgeSearch for more papers by this authorPublished Online:19 Jul 2018https://doi.org/10.1001/jamafacial.2018.0030AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byEmbellishing Emotrics for a More Complete Emotion Analysis: Addition of the Nasolabial Fold Liliana Ein, Lauren Trzcinski, Luke Perry, Kee Yoon Bark, Tessa Hadlock, and Diego L. Guarin1 March 2023 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 0, No. 0Automatic Analysis of Asymmetry in Facial Paralysis Patients Using Landmark-Based Measures Digbalay Bose, Krishna Somandepalli, Tymon Tai, Courtney Voelker, Shrikanth Narayanan, and Amit Kochhar8 November 2022 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 24, No. 6Tri-Vector Gracilis Microneurovascular Free Tissue Transfer with Periocular Component to Achieve a Duchenne Smile in Patients with Facial Paralysis Patrick J. Byrne, Leah J. Novinger, and Dane J. Genther8 November 2022 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 24, No. 6Voluntary and Spontaneous Smile Quantification in Facial Palsy Patients: Validation of a Novel Mobile Application Jordan Fuzi, Catherine Meller, Sydney Ch'ng, Tessa M. Hadlock, and Joseph Dusseldorp21 October 2022 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 0, No. 0Artificial Intelligence-Driven Video Analysis for Novel Outcome Measures After Smile Reanimation Surgery Branislav Kollar, Laura Schneider, Verena K. Horner, Johannes Zeller, Mark Fricke, Zacharias Brugger, Michael Gentz, Jurij Kiefer, and Steffen U. Eisenhardt15 March 2022 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 24, No. 2Reliability Between In-Person and Still Photograph Assessment of Facial Function in Facial Paralysis Using the eFACE Facial Grading System Ronit Malka, Matthew Miller, Diego Guarin, Zoe Fullerton, Tessa Hadlock, and Caroline Banks3 September 2021 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 23, No. 5Toward an Automatic System for Computer-Aided Assessment in Facial Palsy Diego L. Guarin, Yana Yunusova, Babak Taati, Joseph R. Dusseldorp, Suresh Mohan, Joana Tavares, Martinus M. van Veen, Emily Fortier, Tessa A. Hadlock, and Nate Jowett10 February 2020 | Facial Plastic Surgery & Aesthetic Medicine, Vol. 22, No. 1Spontaneity Assessment in Dually Innervated Gracilis Smile Reanimation Surgery Joseph R. Dusseldorp, Martinus M. van Veen, Diego L. Guarin, Olivia Quatela, Nate Jowett, and Tessa A. Hadlock21 November 2019 | JAMA Facial Plastic Surgery, Vol. 21, No. 6Clinician and Automated Assessments of Facial Function Following Eyelid Weight Placement Jacqueline J. Greene, Joana Tavares, Diego L. Guarin, and Tessa Hadlock19 September 2019 | JAMA Facial Plastic Surgery, Vol. 21, No. 5 Volume 20Issue 4Jul 2018 InformationCopyright 2018 American Medical Association. All Rights Reserved.To cite this article:Diego L. Guarin, Joseph Dusseldorp, Tessa A. Hadlock, and Nate Jowett.A Machine Learning Approach for Automated Facial Measurements in Facial Palsy.JAMA Facial Plastic Surgery.Jul 2018.335-337.http://doi.org/10.1001/jamafacial.2018.0030Published in Volume: 20 Issue 4: July 19, 2018PDF download

Test-Retest Reliability and Agreement Between In-Person and Video Assessment of Facial Mimetic Function Using the eFACE Facial Grading System.

Use of a robust high-resolution instrument for grading of facial symmetry would enhance reporting the outcomes of facial reanimation interventions. The eFACE is one such tool. To determine test-retest reliability of the eFACE tool over time and agreement between eFACE assessments made in person vs those made using video of facial mimetic function. A prospective observational study was conducted among 75 consecutive patients with varying degrees of facial palsy who presented between July 1 and December 31, 2014, to an academic tertiary referral hospital. Facial symmetry of all patients was graded in person and via standardized photographic and video documentation of facial mimetic function at the initial visit. Three months after initial presentation, eFACE scores were reassessed by the same raters using the videos of facial mimetic function documented at the initial visit. Individual and subset eFACE scores assessed by 2 facial reanimation surgeons. Among the 75 patients in the study (mean [SD] age, 48.18 [16.60] years; 30 men and 45 women), agreement between in-person and video assessments of facial function using the eFACE scale was excellent (static subset score: mean difference, 0.19; 95% CI, -1.51 to 1.88; P = .83; intraclass correlation coefficient [ICC], 0.85; 95% CI, 0.80 to 0.89; dynamic subset score: mean difference, -0.51; 95% CI, -1.72 to 0.71; P = .41; ICC, 0.96; 95% CI, 0.94 to 0.97; synkinesis subset score: mean difference, -1.14; 95% CI, -2.87 to 0.59; P = .20; ICC, 0.90; 95% CI, 0.86 to 0.93; and composite score: mean difference, -0.41; 95% CI, -1.30 to 0.47; P = .36; ICC, 0.94; 95% CI, 0.92 to 0.96). Agreement between repeated eFACE assessments of video of facial function was excellent (static subset score: ICC, 0.93; 95% CI, 0.87 to 0.96; dynamic subset score: ICC, 0.88; 95% CI, 0.80 to 0.94; synkinesis subset score: ICC, 0.92; 95% CI, 0.86 to 0.96; and composite score: ICC, 0.96; 95% CI, 0.93 to 0.98). Strong agreement exists between eFACE scores of facial function assessed in person and from video recordings. Test-retest reliability of eFACE scores is high. The eFACE is a reliable instrument for high-resolution assessment of facial mimetic function. NA.

Worldwide Testing of the eFACE Facial Nerve Clinician-Graded Scale.

The electronic, clinician-graded facial function scale (eFACE) is a potentially useful tool for assessing facial function. Beneficial features include its digital nature, use of visual analogue scales, and provision of graphic outputs and scores. The authors introduced the instrument to experienced facial nerve clinicians for feedback, and examined the effect of viewing a video tutorial on score agreement. Videos of 30 patients with facial palsy were embedded in an Apple eFACE application. Facial nerve clinicians were invited to perform eFACE video rating and tutorial observation. Participants downloaded the application, viewed the clips, and applied the scoring. They then viewed the tutorial and rescored the clips. Analysis of mean, standard deviation, and confidence interval were performed. Values were compared before and after tutorial viewing, and against scores obtained by an experienced eFACE user. eFACE feedback was positive; participants reported eagerness to apply the instrument in clinical practice. Standard deviation decreased significantly in only two of the 16 categories after tutorial viewing. Subscores for static, dynamic, and synkinesis all demonstrated stable standard deviations, suggesting that the instrument is intuitive. Participants achieved posttutorial scores closer to the experienced eFACE user in 14 of 16 scores, although only a single score, nasolabial fold orientation with smiling, achieved statistically significant improvement. The eFACE may be a suitable, cross-platform, digital instrument for facial function assessment, and was well received by facial nerve experts. Tutorial viewing does not appear to be necessary to achieve agreement, although it does mildly improve agreement between occasional and frequent eFACE users.

Treatment of Temporal Bone Fractures.

Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid (CSF) leak, and hearing loss. Assessment of facial nerve function as soon as possible following injury greatly facilitates clinical decision making. Use of prophylactic antibiotics in the setting of CSF leak is controversial; however, following critical analysis and interpretation of the existing classic and contemporary literature, we believe its use is absolutely warranted.

Improved facial nerve identification during parotidectomy with fluorescently labeled peptide.

Additional intraoperative guidance could reduce the risk of iatrogenic injury during parotid gland cancer surgery. We evaluated the intraoperative use of fluorescently labeled nerve binding peptide NP41 to aid facial nerve identification and preservation during parotidectomy in an orthotopic model of murine parotid gland cancer. We also quantified the accuracy of intraoperative nerve detection for surface and buried nerves in the head and neck with NP41 versus white light (WL) alone. Twenty-eight mice underwent parotid gland cancer surgeries with additional fluorescence (FL) guidance versus WL reflectance (WLR) alone. Eight mice were used for additional nerve-imaging experiments. Twenty-eight parotid tumor-bearing mice underwent parotidectomy. Eight mice underwent imaging of both sides of the face after skin removal. Postoperative assessment of facial nerve function measured by automated whisker tracking were compared between FL guidance (n = 13) versus WL alone (n=15). In eight mice, nerve to surrounding tissue contrast was measured under FL versus WLR for all nerve branches detectable in the field of view. Postoperative facial nerve function after parotid gland cancer surgery tended to be better with additional FL guidance. Fluorescent labeling significantly improved nerve to surrounding tissue contrast for both large and smaller buried nerve branches compared to WLR visualization and improved detection sensitivity and specificity. NP41 FL imaging significantly aids the intraoperative identification of nerve braches otherwise nearly invisible to the naked eye. Its application in a murine model of parotid gland cancer surgery tended to improve functional preservation of the facial nerve. NA Laryngoscope, 126:2711-2717, 2016.

Clinical and electromyographic assessment of facial nerve function after temporomandibular joint surgery

The aim of this study was to evaluate the factors that may cause alterations in facial nerve function during temporomandibular joint (TMJ) surgeries. Forty-six patients were included (66 joints) between the years 2000 and 2007. Study patients were those undergoing various surgical procedures for the treatment of TMJ disorders. Patients who had made an incomplete recovery from a facial nerve injury resulting from a previous operation and patients who presented with facial palsy after a previous TMJ surgery were excluded. The facial nerve function of all patients was evaluated at different time intervals using a facial nerve grading system, motor unit action potentials of the frontalis and orbicularis oculi muscles, and a facial nerve latency test. Various degrees of facial nerve affliction were initially noticed in 71% of the study cases (47 of 66 joints). Statistical analyses (χ2 goodness-of-fit) revealed that several factors could lead to facial nerve injury following TMJ surgery, including the design of the skin incision, prior surgeries, type of surgery, and duration of surgery. Facial nerve injury during TMJ surgery is multifactorial. Electromyographic studies are non-invasive and valuable diagnostic and prognostic tools for assessing facial nerve function.

The Functionality of Facial Appearance and Its Importance to a Korean Population

BackgroundMany people have an interest in the correction of facial scars or deformities caused by trauma. The increasing ability to correct such flaws has been one of the reasons for the increase in the popularity of facial plastic surgery. In addition to its roles in communication, breathing, eating, olfaction and vision, the appearance of the face also plays an important role in human interactions, including during social activities. However, studies on the importance of the functional role of facial appearance. As a function of the face are scare. Therefore, in the present study, we evaluated the importance of the functions of the face in Korea.MethodsWe conducted an online panel survey of 300 participants (age range, 20-70 years). Each respondent was administered the demographic data form, Facial Function Assessment Scale, Rosenberg Self-Esteem Scale, and standard gamble questionnaires.ResultsIn the evaluation on the importance of facial functions, a normal appearance was considered as important as communication, breathing, speech, and vision. Of the 300 participants, 85% stated that a normal appearance is important in social activities.ConclusionsThe results of this survey involving a cross-section of the Korean population indicated that a normal appearance was considered one of the principal facial functions. A normal appearance was considered more important than the functions of olfaction and expression. Moreover, a normal appearance was determined to be an important facial function for leading a normal life in Korea.

A Comparison of Facial Nerve Grading Systems

This study aimed to compare a computerized tool to standard objective clinical scales for global and zone-specific assessment of facial nerve function. This was a retrospective review of 77 patients with facial paralysis who underwent facial videography. Videos were independently scored by 3 facial nerve specialists using the House-Brackmann Scales (HBI and HBII). Digital scoring was performed with Facogram software. Scores were recorded and compared using intraclass and Pearson (r) correlations. Interobserver correlation was high with HBII, with overall scores in excellent agreement (intraclass correlation range, 0.78-0.95; P ≤ 0.0001). There were strong correlations between Facogram and HBII (r ≥ 0.67, P ≤ 0.0001) and strong intraobserver correlations between HBI and HBII (r ≥ 0.71, P ≤ 0.0001). The HBII required more clinician time [mean (SD), 72 (21) seconds per case], compared with Facogram, which did not require any clinician time. An automated, zone-specific facial analysis tool can eliminate clinician subjectivity and allow standardized assessment of facial paralysis.

Reliability of postoperative photographs in assessment of facial nerve function after vestibular schwannoma resection

This study was undertaken to assess the reliability of observations of postoperative photographs in assigning House-Brackmann scores as outcome measures for patients following resection of vestibular schwannomas. Forty pictures of differing facial expressions typically elicited from patients for assigning House-Brackmann scores were individually evaluated by neurosurgery residents and faculty members at the University of Alabama at Birmingham; a score was assigned to each picture by the individual raters. The interrater reliability was measured using the Spearman correlation coefficient, Kendall coefficient of concordance, and kappa statistic; internal consistency was calculated using the Cronbach alpha reliability estimate. The Spearman correlation coefficients showed strong positive association among raters, with a range of values of 0.66 to 0.90. Internal consistency measured by the Cronbach alpha coefficient was excellent (α = 0.97). The Kendall coefficient of concordance for the ordinal grades suggested a substantial degree of agreement among the raters (w = 0.76, p < 0.001). Static postoperative photographs are a reliable outcome measure for determining facial nerve function after vestibular schwannoma resection and may serve as a surrogate for the dynamic patient interview.

Antidromically Evoked Facial Nerve Response in Guinea Pigs – A Long-Term Follow-Up after Nerve Injury

Conclusion: The present animal experiment supported that the antidromically evoked facial nerve response (AFNR) was useful for the early diagnosis of facial palsy and for assessing its recovery course. Objective: Chronological changes of AFNR latencies after nerve damage were investigated to examine whether or not AFNR latency was suitable as a parameter for the assessment of facial nerve function. Materials and Methods: AFNR were recorded in guinea pigs with and without the total or partial transection of the facial nerve. Chronological changes of AFNR after facial nerve transection were investigated. Results: 48 h after the total transection, the responses almost completely disappeared, and reappeared after 3 weeks. The latencies of the recovered responses were prolonged then but shortened thereafter. Meanwhile, the partial transection did not result in a total loss of AFNR, but in a decrease of the amplitude and prolongation of the latency. One day after the partial transection, the latencies of the responses had already prolonged. From the 3rd to the 7th day, the latencies progressively prolonged, and then shortened by the 14th day.