Facial Clinimetric Evaluation Research Articles

The Effectiveness of Facial Neuromuscular Retraining on Patients with Facial Nerve Dysfunction: A Mental Health and Quality of Life Analysis.

Background: Facial muscle dysfunction can have drastic psychosocial effects. Objectives: To evaluate the impacts of customized neuromuscular retraining on mental health, quality of life (QoL), facial muscle function, and synkinesis. Methods: Thirty patients with facial nerve dysfunction completed a course of neuromuscular retraining. Patients' mental health, QoL, facial muscle function, and synkinesis were evaluated using Patient Health Questionnaire (PHQ-9), Facial Clinimetric Evaluation (FaCE) scale, electronic, clinician-graded facial function scale (eFACE), and Synkinesis Assessment Questionnaire (SAQ) at the initial and final visits. Scores were compared before and after treatment. Results: Patients (n = 30) included had a mean age of 59.4 ± 13.4 years (range 32.3-82.8) and were mostly female (22/30, 73.3%). The most common etiology was Iatrogenic facial nerve paralysis (11/20, 36.7%). Most patients had postfacial paralysis synkinesis (15/30, 50%), while 10 had complete flaccid paralysis. The median house-Brackmann score was 2 (range 1-6). The mean duration of facial palsy was 39.5 ± 106.9 (range 1-576 months). The duration of follow-up after the initial treatment session was 5.5 months, including 10 sessions. After neuromuscular retraining median PHQ-9 scores improved from 5 (range 0-25) to 3 (range 0-20) (p = 0.002). Mean FaCE PROM scores increased from 47.7 ± 11.5 to 56.5 ± 8.8 (p = 0.001). The mean eFACE score increased from 55.8 ± 15.1 to 71.7 ± 13.6 (p < 0.001). Median SAQ score was lower at the final visit (34.6 ± 13.4) compared to the initial visit (47.7 ± 17.8; p < 0.001). Conclusion: Customized neuromuscular retraining may improve patient-reported mental health, QoL, and facial muscle function and reduce synkinesis in facial nerve dysfunction.

Rehabilitation Surgery for Peripheral Facial Nerve Injury after Facial Trauma

Abstract Introduction Facial trauma can cause damage to the facial nerve, which can have negative effects on function, aesthetics, and quality of life if left untreated. Objective To evaluate the effectiveness of peripheral facial nerve direct end-to-end anastomosis and/or nerve grafting surgery for patients with facial nerve injury after facial trauma. Methods Fifty-nine patients with peripheral facial nerve paralysis after facial injuries underwent facial nerve rehabilitation surgery from November 2017 to December 2021 at Ho Chi Minh City National Hospital of Odontology. Results All 59 cases of facial trauma with damage to the peripheral facial nerve underwent facial nerve reconstruction surgery within 8 weeks of the injury. Of these cases, 25/59 (42.3%) had end-to-end anastomosis, 22/59 (37.3%) had nerve grafting, and 12/59 (20.4%) had a combination of nerve grafting and end-to-end anastomosis. After surgery, the rates of moderate and good recovery were 78.4% and 11.8%, respectively. All facial paralysis measurements showed statistically significant improvement after surgery, including the Facial Nerve Grading Scale 2.0 (FNGS 2.0) score, the Facial Clinimetric Evaluation (FaCE) scale, and electroneurography. The rate of synkinesis after surgery was 34%. Patient follow-up postoperatively ranged from 6 to &gt; 36 months; 51 out of 59 patients (86.4%) were followed-up for at least 12 months or longer. Conclusion Nerve rehabilitation surgery including direct end-to-end anastomosis and nerve grafting is effective in cases of peripheral facial nerve injury following facial trauma. The surgery helps restore nerve conduction and improve facial paralysis.

Effect of Underlying Mental Health Disorders on the Correlation Between Patient- and Surgeon-Graded Synkinesis Scores.

Background: Little is known about how depression and appearance anxiety affect patient reporting of synkinesis severity. Learning/Study Objective: Measure prevalence of depression and appearance anxiety in facial synkinesis and correlations between subjective and surgeon-graded synkinesis severity. Design Type: Prospective cohort. Methods: Patients with synkinesis volunteered and completed: Synkinesis Assessment Questionnaire (SAQ), facial clinimetric evaluation (FaCE) scale, Center for Epidemiological Studies Depression Scale (CES-D), and Fear of Negative Appearance Evaluation Scale (FNAES). Standardized videos were scored by facial plastic surgeons using Sunnybrook Scale and eFaCE. Multivariate linear regression was used to compare patient- and surgeon-graded metrics. Results: One hundred patients participated, 91 were female. Mean age was 56.4 (12.3). Eight percent identified as Black and 87% White. The most common nerve injury etiology was idiopathic (47%). Mean synkinesis duration was 7.6 years (6.2). Twenty percent and 15% reported history of an anxiety or depressive disorder, respectively. Patient (SAQ, FaCE) and clinician (Sunnybrook, eFaCE) scores were correlated (Pearson's r 0.223-0.294, p < 0.05). Upon adjusting for CES-D/FNAES, correlations between most patient and clinician metrics became stronger. As CES-D and FNAES worsened, patient-clinician correlations weakened. Conclusions: Depression and appearance anxiety may affect patient reporting of synkinesis severity. Worse mental health scores may decorrelate patient and clinician synkinesis assessments.

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&lt;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.

Unraveling Bell's Palsy: Exploring HSV's Role and Facial Therapy's Impact on Aberrant Reinnervation and Synkinesis.

Bell's Palsy, a disorder characterized by the abrupt onset of facial paralysis, has a significant impact on individuals globally. The precise contribution of the Herpes Simplex Virus (HSV) to its aetiology remains uncertain. The present study investigates the correlation between Herpes Simplex Virus (HSV) and Bell's Palsy, as well as evaluates the effectiveness of specialized facial therapy in its treatment. A five-year longitudinal study was conducted at a tertiary care centre, with a sample of 100 patients diagnosed with Bell's Palsy, ranging in age from 18 to 65 years. The participants were divided into two groups: one receiving normal treatment and the other receiving specialized facial therapy. The assessments included HSV testing, the House-Brackmann scale for evaluating facial nerve function, the Facial Clinimetric Evaluation (FaCE) scale for assessing quality of life, and measures of patient satisfaction. The findings of the study revealed evidence supporting a robust association between HSV and the severity of Bell's Palsy. Significantly, individuals who underwent specialized facial therapy exhibited significant enhancements in facial nerve function, a decrease in synkinesis episodes, and better scores suggesting improved quality of life compared to those who received standard care. Additionally, this particular cohort also confirmed a noteworthy rise in patient satisfaction. This study indicates the potential association between HSV and Bell's Palsy while emphasizing the advantages of facial therapy. The above findings are of great significance; however, additional research is required in order to develop more precise ways of managing Bell's Palsy. The online version contains supplementary material available at 10.1007/s12070-023-04275-2.

Pre-Operative Factors May Predict Outcome in Selective Neurectomy for Synkinesis.

Background: While there has been great interest in offering selective neurectomy (SN) to patients with nonflaccid facial palsy (NFFP), postoperative outcomes are inconsistent. Objective: To assess overall SN outcome in NFFP patients and to examine correlation between preoperative factors and SN outcome. Methods: SN cases were retrospectively identified between 2019 and 2021. Patient factors and facial function were assessed using chart review, the Facial Clinimetric Evaluation (FaCE), the electronic clinician-graded facial function tool (eFACE), and an automated computer-aided facial assessment tool (Emotrics). Correlations between preoperative factors and patients outcome were established. Results: Fifty-eight SN cases were performed; 88% were females, and median age was 53 years (range 11-81). Outcome assessment was 8 months on average (1-24 months). Postoperatively, multiple eFACE and Emotrics parameters improved significantly, including ocular, perioral, and synkinesis metrics. In preoperative factors assessment, age >50, facial palsy (FP) duration >2 years, poor preoperative facial function, and nontrauma etiology all correlated with greater improvements compared with younger patients, those with shorter duration facial palsy, trauma etiology, and better preoperative facial function. Conclusions: SN can significantly improve facial function; we have identified several preoperative factors that correlated to outcome.

Effect of botulinum toxin type A in functionality, synkinesis and quality of life in peripheral facial palsy sequelae

ObjectivesThis study aimed to assess the effects of botulinum toxin A (BTX-A) infiltration on face muscle function, synkinesis, and quality of life in patients with sequelae of peripheral facial palsy (PFP). Material and methodsWe present the results of a prospective study including a sample of 20 patients with sequelae of PFP (15 women, 5 men) who underwent BTX-A (Botox© or Xeomin©) infiltration. All patients had previously received personalised treatment with neuromuscular retraining. A clinical assessment was performed before BTX-A infiltration and 4 weeks after treatment. The effect of BTX-A on face muscle function, quality of life, and synkinesis was evaluated using the Sunnybrook Facial Grading System (SFGS), the Facial Clinimetric Evaluation (FaCE) questionnaire, and the Synkinesis Assessment Questionnaire (SAQ), respectively. ResultsMean SFGS scores increased from 64.8 to 69.9 after BTX-A infiltration (P=.004). Increases were also observed in mean total FaCE scores (from 52.42 to 64.5; P<.001) and the mean score on the FaCE social function subscale (from 61.15 to 78.44; P<.001). Mean SAQ scores decreased from 46.22 to 37.55 after BTX-A infiltration (P=.001). ConclusionsBTX-A infiltration increases face muscle function, improves quality of life, and reduces synkinesis in patients with sequelae of PFP.

The Facial Clinimetric Evaluation scale underestimates social well-being and synkinesis in overall facial palsy-specific quality of life: A cross-sectional study in 80 patients.

The Facial Clinimetric Evaluation scale underestimates social well-being and synkinesis in overall facial palsy-specific quality of life: A cross-sectional study in 80 patients.

Translation and validation of a Finnish version of the Facial Clinimetric Evaluation (FaCE) Scale

Background: The Facial Clinimetric Evaluation (FaCE) scale is a patient-reported health status instrument developed for assessing the health-related quality of life (HRQoL) in patients with facial nerve paralysis. The aim of this study was to translate and validate the FaCE scale for the Finnish-speaking population.Methods: The FaCE scale was translated according to international guidelines. Sixty patients in an outpatient clinic prospectively completed the translated FaCE scale and generic HRQoL instrument (15D). The objective facial paralysis grading was made using the Sunnybrook and House-Brackmann scales. Repeated FaCE and 15D instruments were mailed to patients 2 weeks later. Total scores of the FaCE instrument and subscales were calculated, and floor and ceiling effects were examined. Exploratory factor analysis was made. Internal consistency, reliability, and repeatability were assessed. Convergence with 15D instrument, Sunnybrook, and House-Brackmann scales was examined.Results: The total internal consistency of the FaCE scale was high (Cronbach’s alpha 0.83). There were no statistically significant differences found between mean scores of the subscales in test-retest analysis (p &gt; 0.05). Intra-class correlations coefficients were high, ranging between 0.78 and 0.92, and the correlations were statistically significant (p &lt; 0.001). There were statistically significant correlations observed between the FaCE scale and the 15D, Sunnybrook, and House-Brackmann scores. Conclusion: The FaCE scale was successfully translated and validated in Finnish with good validity and reliability. We also demonstrated statistically significant correlations between the generic HRQoL15D instrument and both the Sunnybrook and House-Brackmann physician-based grading scales. The FaCE scale is now ready for use in Finnish facial paralysis patients.

“Does the Exploration of the Temporomandibular Joint Using a Deep Subfascial Technique Result in a Superior Operative Outcome?”

The literature is replete with various approaches for the temporomandibular joint (TMJ), each with its own distinct advantages and disadvantages. None of these approaches, however, have been associated with superior operative outcomes. The purpose of this study was to measure the efficacy of three operative approaches to TMJ, namely superficial, subfascial, and deep subfascial approaches. The aim was to contrast selected intraoperative and postoperative outcomes among these surgical approaches. This was a prospective randomized clinical trial of subjects presenting to outpatient department. The primary predictor variables were three dissection planes of TMJ: Group-I (superficial), Group-II (subfascial), and Group-III (deep subfascial). The primary outcome variables were quality of surgical field employing fromme scale, dissection time in minutes, amount of blood loss in milliliters, and facial nerve function (FNF) using House-Brackmann scale. The secondary outcome variables were postoperative pain using visual-analog scale and swelling in millimeters measured on 1st, 3rd, and 7th postoperative days and quality of life using facial clinimetric evaluation questionnaire at 6-month follow-up. Age, gender, side, diagnosis, and type of surgery were the covariates. The data were analyzed using descriptive, comparative, and regression analysis. A P value of less than .05 was considered statistically significant. The study included thirty subjects (8 males and 22 females) with various TMJ disorders ranging in age from 8 years to 65years (mean 27.83±10.52). On evaluation of intraoperative parameters, subfascial approach had statistically significant superior quality of surgical field (Group-I: 1.90±0.57; Group-II: 1.10±0.32; Group-III: 1.40±0.52; P value=.006), statistically significant shortest dissection time (Group-I: 18.30±3.74min; Group-II: 13.240±1.96min; Group-III: 16.20±1.99min; with P value=.03), and statistically significant lower amount of blood loss compared with other groups(Group-I: 92.40±4.74ml: Group-II: 82.30±3.77ml; Group-III: 84.60±3.06ml; Pvalue<.001). On assessment of postoperative parameters, only FNF of temporal branch showed statistically significant difference from 24 hours till 3 months with better outcome in deep subfascial approach. Mean scores of FNF at 24 hours and 1-week (Group-I: 4.20±2.39; Group-II: 2.40±2.27; Group-III: 1.50±1.58 P=.02) and 1-month and 3-month (Group-I: 2.70±1.82; Group-II: 1.20±0.63; Group-III: 1.00±0.00 P=.04). The subfascial approach significantly improved intraoperative outcomes and deep subfascial approach was comparatively safe with fewer incidence of facial nerve injury.

Guided Self-rehabilitation Contract vs conventional therapy in chronic peripheral facial paresis: VISAGE, a multicenter randomized controlled trial

BackgroundOne year after persistent peripheral facial paresis (PFP), prescriptions of conventional rehabilitation are often downgraded into maintenance rehabilitation or discontinued, the patient entering what is seen as a chronic stage. This therapeutic choice is not consistent with current knowledge about behavior-induced plasticity, which is available all life long and may allow intense sensorimotor rehabilitation to remain effective. This prospective, randomized, multicenter single-blind study in subjects with chronic unilateral PFP evaluates changes in facial motor function with a Guided Self-rehabilitation Contract (GSC) vs. conventional therapy alone, carried out for six months.MethodsEighty-two adult subjects with chronic unilateral PFP (> 1 year since facial nerve injury) will be included in four tertiary, maxillofacial surgery (2), otolaryngology (1) and rehabilitation (1) centers to be randomized into two rehabilitation groups. In the experimental group, the PM&R specialist will implement the GSC method, which for PFP involves intensive series of motor strengthening performed daily on three facial key muscle groups, i.e. Frontalis, Orbicularis oculi and Zygomatici. The GSC strategy involves: i) prescription of a daily self-rehabilitation program, ii) teaching of the techniques involved in the program, iii) encouragement and guidance of the patient over time, in particular by requesting a quantified diary of the work achieved to be returned by the patient at each visit. In the control group, participants will benefit from community-based conventional therapy only, according to their physician’s prescription. The primary outcome measure is the composite score of Sunnybrook Facial Grading System. Secondary outcome measures include clinical and biomechanical facial motor function quantifications (Créteil Scale and 3D facial motion analysis through the Cara system), quality of life (Facial Clinimetric Evaluation and Short-Form 12), aesthetic considerations (FACE-Q scale) and mood representations (Hospital Anxiety and Depression scale). Participants will be evaluated every three months by a blinded investigator, in addition to four phone calls (D30/D60/D120/D150) to monitor compliance and tolerance to treatment.DiscussionThis study will increase the level of knowledge on the effects of intense facial motor streng-         Facial paralysisthening prescribed through a GSC in patients with chronic peripheral facial paresis.Trial registrationClinicalTrials.gov, NCT04074018. Registered 29 August 2019.Protocol versionVersion N°4.0—04/02/2021.

Early Simultaneous Cross Facial Nerve Graft and Masseteric Nerve Transfer for Facial Paralysis after Tumor Resection.

Patients undergoing masseter nerve transfer and CFNG for facial paralysis after skull base tumor resection were consented to participate in video interviews. Facial Clinimetric Evaluation (FaCE) Scale (0-100) patient-reported outcome, eFACE, and Facial Grading Scale scores were compared. Nine patients had unilateral facial paralysis from resection of a schwannoma (56%), acoustic neuroma (33%), or vascular malformation (11%). Five underwent early simultaneous CFNG and masseter nerve transfer (mean 3.6 days after resection), whereas four underwent two-stage reanimation including a babysitter procedure (mean 218 days after resection). Postoperative FaCE scale and Facial Grading Scale scores were similar in both groups (P > 0.05). Postoperative mean eFACE scores were similar for both groups for smile (early: 71.5 versus delayed: 75.5; P = 0.08), static (76.3 versus 82.1; P = 0.32), and dynamic scores (59.7 versus 64.9; P = 0.19); however, synkinesis scores were inferior in the early group (76.4 versus 91.1; P = 0.04). Early simultaneous masseter nerve transfer and CFNG provides reanimated movement sooner and in fewer stages than a staged approach in a delayed timeline. The early technique appears to result in similar clinician- and patient-reported outcomes compared with delayed procedures; however, in this preliminary study, the early approach was associated with greater synkinesis, meriting further investigation.

Sensory function in the faces of patients with facial palsy: A prospective observational study using quantitative sensory testing.

To determine the sensory function of both sides of the face in patients with acute or chronic facial palsy. Prospective observational study. The standardized quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain (DFNS), including thermal or mechanical stimuli (touch, pain, vibration, and pressure), was used to investigate somatosensory function in the faces of patients. A patient-reported outcome measures for the assessment of disturbed facial comfort or facial pain, the facial Clinimetric Evaluation Scale (FaCE) Facial Comfort Subscale, and the 36-Item Short Form Survey (SF-36) pain subdomain were used. A total of 29 patients (22 female, median age of 48 years; 7 acute palsy; 22 chronic palsy; House-Brackmann grade II-VI) were included. The median FaCE Facial Comfort Subscale score and the median SF-36 pain subdomain score were 50 and 100, respectively. Most patients had, at an individual level, a normal sensory function in all or most tests. On average, the frequencies for all parameters were not different between the paretic side and the contralateral side (all p > 0.05). Additionally, when z-scores were used to compare our patient sample with healthy controls from the DFNS reference database, there was no difference between the paretic side and the contralateral side (all p > 0.05). Furthermore, there were no differences between patients with acute facial palsy and those with chronic facial palsy (all p > 0.05). The FaCE Facial Comfort Subscale score and the SF-36 pain subdomain score did not correlate with the QST parameters (all p > 0.05). Patients with acute or chronic unilateral peripheral facial palsy had normal sensory function on the paretic and contralateral sides compared with the reference values of healthy controls, and there was no significant difference between the sides. The numbness frequently felt in the affected hemiface is not related to a peripheral sensory disorder and is most likely a manifestation of an unsolved cortical somatosensory-motor mismatch.

Facial Nerve Exploration for Known or Suspected Transection: The Massachusetts Eye and Ear Experience.

Background: There is no ideal test to determine likelihood of spontaneous recovery after post-traumatic and postsurgical facial palsy (FP). Objective: Among patients with unexpected FP undergoing facial nerve (FN) exploration for suspected discontinuity, we endeavored to discern whether intraoperative findings, repair type, and time to exploration impact FN recovery, as measured by electronic Facial Clinimetric Evaluation (eFACE) and FaCE scales. Methods: Retrospective cohort study of 42 adult patients who underwent FN exploration. Results: FN injury resulted from either surgery (n = 29) or trauma (n = 13). Average time to repair was 68.4 (standard deviation 79.6) days. Postoperative improvements were observed in total eFACE (73.3-86.5; p < 0.0001) and FaCE (21.5-38.1; p = 0.0214) scores. Distal FN injuries were most common (n = 29) and had best recovery (percentage change in eFACE 57.2% vs. 34.3% main trunk, p = 0.0306). Discontinuity injuries (n = 33) repaired with primary coaptation (n = 18) had noninferior outcomes compared with cable graft repair (n = 16; percentage change in eFACE 49.6% vs. 39.2%, p = 0.3470). Denervation times <3 months yielded better recovery using percentage change in eFACE score (56.9% vs. 33.1%, p = 0.0270). Conclusions: Surgical exploration for unexpected FP allows for direct visualization of anatomical nerve status and timely repair.

Synkinesis and Communicative Participation.

Background: Facial palsy (FP) impacts verbal and nonverbal communication, but the effect of synkinesis on communicative ability is unknown. Objective: Among patients with nonflaccid FP, or synkinesis, is there a correlation between disease-specific quality-of-life and communicative ability or dysfunction? Methods: Retrospective study of a series of adult patients with unilateral synkinesis. Subjects were evaluated using the Communicative Participation Item Bank (CPIB) Short Form, Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Associations between these scales were evaluated by computing Pearson correlation coefficients. Results: A total of 69 confirmed synkinesis patients were included. Synkinesis patient mean (standard deviation) CPIB score was 20.68 (±8.27; range of scale 0-30), indicative of communication restriction. A strong correlation was observed between total CPIB and FaCE scores (r = 0.66), indicating patients with synkinesis who reported better facial function also reported greater communicative ability. There was a weak correlation between CPIB and SAQ scores (r = -0.27). Conclusion: Synkinesis is associated with significant deficits in communicative ability. Communication restrictions track strongly with the FaCE scale.

Psychometric properties of the Turkish version of the Facial Clinimetric Evaluation scale for patients with Bell's palsy

Psychometric properties of the Turkish version of the Facial Clinimetric Evaluation scale for patients with Bell's palsy

Comparative Study of Multimodal Therapy in Facial Palsy Patients.

Introduction  In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes. Methods  Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale. Results  FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, –24.51 to –14.66, p  < 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly ( p  < 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment ( p  < 0.01), more chemodenervation episodes ( p  < 0.01), increased doses of botulinum toxin ( p  < 0.001), and having higher EGGS score ( p  < 0.001). Conclusions  This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.

Influence of Subclinical Anxiety and Depression on Quality of Life and Perception of Facial Paralysis.

Introduction: Patients with facial paralysis have increased psychosocial distress, which affects overall quality of life (QOL). Objective: To evaluate the relationship between QOL and paralysis severity among patients with subclinical anxiety and/or depression. Methods: Patients with facial paralysis were screened for anxiety and depression using the Generalized Anxiety Disorder-2 and Patient Health Questionnaire-2 surveys. QOL scores (Facial Clinimetric Evaluation) and paralysis severity scores (House-Brackmann [HB] and Sunnybrook [SB]) were collected. Patients with a mental health diagnosis or treatment were excluded. Univariate and multivariate analyses and Pearson's correlations were performed after stratifying by anxiety and/or depression screenings. Results: Positive anxiety and depression screening rates were 25.78% and 22.66%, respectively. Patients screening positive had significantly worse QOL scores despite no difference in paralysis severity. QOL scores did not correlate with SB scores among patients who screened positive for depression. Conclusion: Patients screening positive for anxiety and/or depression demonstrated worse QOL, which did not correlate with paralysis severity suggesting that health care professionals should remain alert to mental health symptoms when QOL impairment is out of proportion with the severity of paralysis.

Psychometric properties of the Facial Disability Index in patients with facial palsy: a systematic review and meta-analysis.

The aim of the study was to present the systematic review and meta-analysis of the psychometrical analysis of Facial Disability Index (FDI) studies. A literature search was conducted in the relevant electronic databases "PubMed, Scopus, Web of Science (WoS), and Cochrane Library." A total of 621 articles were obtained by searching the relevant keywords (PubMed: 384, Cochrane Library: 14, Web of Science: 132, Scopus: 91). A total of 8 papers were included. The four-point classification and rating-based "COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)" tools were used to evaluate the bias risk and evidence levels. Cronbach's alpha pooling of FDI total score was (ES): 0.803 (95% CI: 0.73-0.86). Heterogeneity for the Facial Disability Index-Physical Function (FDI-PF) and Facial Disability Index-Social Function (FDI-SF) subscore based on intraclass correlation coefficient (ICC) were I2 = 84.2% (ICC: 0.88, 95% CI: 0.81-0.92) and I2 = 73.7% (ICC: 0.87, 95% CI: 0.81-0.90), respectively. Correlational results between Sunnybrook Facial Grading System (SFGS) with FDI-PF and FDI-SF were 0.38 and 0.22, respectively. The correlations of FDI-PF with Short Form-12 Physical Component Summary (SF-12-PCS) and Short Form-12 Mental Health Component Summary (SF-12-MCS) were 0.43 and0.28, respectively. Correlation results of FDI-SF with SF-12-PCS and SF-12-MCS were 0.23 and 0.57. The relationship results of Facial Clinimetric Evaluation with FDI-PF and FDI-SF were 0.71 and 0.57, respectively. FDI is a psychometrically valuable questionnaire, especially for the internal consistency, reliability, and validity. In clinical practice, the use of FDI would be valuable, in addition to clinician-based grading, to see more of patients' social influences precisely.

Multiple Model Evaluation of the Masseteric-to-Facial Nerve Transfer for Reanimation of the Paralyzed Face and Quick Prognostic Prediction.

Facial paralysis is negatively associated with functional, aesthetic, and psychosocial consequences. The masseteric-to-facial nerve transfer (MFNT) has many advantages in facial reanimation. The aim is to evaluate the effectiveness of our MFNT technique and define the potential factors predictive of outcome. The authors conducted a retrospective review of 20 consecutive patients who underwent MFNT using the temporofacial trunk of facial nerve. Videotapes and images were documented and evaluated according to Facial Nerve Grading Scale 2.0 (FNGS2.0) and Sunnybrook Facial Grading System (FGS). The quality-of-life was obtained using the Facial Clinimetric Evaluation (FaCE) Scale. Moreover, Facial Asymmetry Index (FAI), quantitative measurement of the width of palpebral fissure, deviation of the philtrum, and angles or excursions of the oral commissure were applied to explore the effect of the transfer metrically. Multivariable logistic regression models and Cox regression were prepared to predict the effect of MFNT by preoperative clinical features. The patients showed favorable outcomes graded by FNGS2.0, and experienced significantly improved scores in static and dynamic symmetry with slightly elevated scores in synkinesis evaluated by the Sunnybrook FGS. The score of FaCE Scale increased in all domains after reanimation. The quantitative indices indicated the symmetry restoration of the middle and lower face after MFNT. Regression analysis revealed that younger patients with severe facial paralysis are preferable to receive MFNT early for faster and better recovery, especially for traumatic causes. The findings demonstrate that MFNT is an effective technique for facial reanimation, and case screening based on clinical characteristics could be useful for surgical recommendation.