Health-related quality of life in 794 patients with a peripheral facial palsy using the FaCE Scale: a retrospective cohort study.

OBJECTIVES: To describe the health-related quality of life of patients visiting a tertiary referral centre for facial palsy, and to analyse factors associated with health-related quality of life, using the FaCE Scale instrument. DESIGN: Retrospective cohort study. SETTING: The Facial Nerve Center at the Massachusetts Eye and Ear Infirmary, a tertiary referral centre. PARTICIPANTS: Patients with a peripheral facial palsy visiting the centre for an initial consultation between August 2007 and June 2012. MAIN OUTCOME MEASURES: The total FaCE score and the FaCE social function subdomain. Multiple regression models were developed to identify factors associated with the total FaCE score and FaCE social function score. RESULTS: A total of 794 patients with a mean age of 47.0 ± 16.0 years were analysed in this study, of which 59.9% were female. The mean House-Brackmann, Sunnybrook, total FaCE and FaCE social function scores were 3.6 ± 1.5, 48.2 ± 21.2, 47.3 ± 19.3 and 55.5 ± 19.2, respectively. Increasing age (r = -0.229, P < 0.001) was associated with a lower total FaCE score. Female gender (r = -4.422, P = 0.033) and increased duration of palsy (r = -0.018, P = 0.041) were associated with lower FaCE social function scores. CONCLUSIONS: While counselling patients on what to expect during the recovery process after facial paralysis is an important part of any clinical visit, FaCE score correlations suggest that female patients with chronic facial palsy and increased age constitute a patient category that may require additional time and attention to prevent or mitigate psychosocial dysfunction.

Facial reanimation procedures depicted on radiologic imaging.

Various facial reanimation procedures can be performed for treating patients with chronic facial nerve paralysis. The radiologic imaging features of static and dynamic techniques are reviewed in this article with clinical correlation, including brow lift, eyelid weights and springs, gracilis free flaps, fascia lata grafts, temporalis flaps, and Gore-Tex suspension slings. Although the anatomic alterations resulting from facial reanimation surgery may not necessarily be the focus of the imaging examination, it is important to recognize such changes and be familiar with MR imaging compatibility of the associated implanted materials. Furthermore, imaging is sometimes used to specifically evaluate the postoperative results, such as vessel patency following free gracilis transfer.

A new artificial nerve graft containing rolled Schwann cell monolayers.

This study hypothesized that introducing high numbers of Schwann cells in monolayers via a novel rolled graft architecture would promote robust nerve regeneration. The objective was to place adherent Schwann cells in artificial nerve grafts and to assess regeneration through the Schwann cell-laden grafts compared with that through acellular grafts and autografts. Schwann cells were isolated from neonatal Fisher rats. Small intestinal submucosa (SIS) was harvested from adult Fisher rats, cut into 7 mm x 8 cm pieces, and pinned out. Schwann cells were plated onto the strips, allowed to reach confluence, and subsequently rolled into a laminar structure and implanted across a 7-mm gap in the rat sciatic nerve (n = 12). Control animals received SIS conduits without Schwann cells (n = 11) or autograft repair (n = 12). At 10.5 weeks, functional regeneration through the Schwann cell-laden grafts, measured by both sciatic function index and extensor postural thrust testing, exceeded that through the cell-free grafts and approached that achieved through autografts. These results highlight the role of Schwann cells in nerve regeneration. Regenerative results approaching autograft levels in the Schwann cell-laden group suggest that this methodology may ultimately be useful in clinical nerve repair.

Quantification of functional recovery following rat sciatic nerve transection.

Functional recovery following experimental nerve injury has been notoriously difficult to quantify precisely. The current gold standard in the rat sciatic nerve model involves analysis of footprints of the recovering animal, and computation of the sciatic function index (SFI). We performed transection injuries and measured recovery both by walking track analysis and by a newer, simpler, more quantitative test of motor recovery, the extensor postural thrust (EPT). We demonstrate a high correlation between both testing modalities and suggest a role for EPT measurements as an easier, more consistent measure of motor recovery following experimental rat sciatic nerve transection.

A comparison of assessments of functional recovery in the rat.

Assessment of functional recovery following any peripheral nerve manipulation is critical. While quantitative neurobehavioral testing has been developed in the anesthesia literature for the assessment of neural function, the surgical literature relies mainly on walking track analysis for evaluation of motor recovery. The latter method is both cumbersome to perform and difficult to quantify. We compared standard walking track analysis with the quantitative neurobehavioral tests recently developed for anesthetic testing. We found a close correlation between the recovery predicted by walking track analysis and that suggested by neurobehavioral testing. In addition, the neurobehavioral test battery offered information regarding the rate of return of pure motor function, complex integrated function, proprioceptive function, and sensation. The tests are easier to perform and less susceptible to interpretative error. Neurobehavioral testing may be an effective substitute for walking track analysis in the assessment of functional recovery following manipulation of the rat sciatic nerve.

Update on facial nerve repair.

Facial paralysis is a complex clinical problem, and optimal management strategies continue to evolve. Areas of active investigation include improvements in neural repair techniques, and the examination of new anastomotic materials and methods, as well as the development of alternative neural bridging materials. Current controversies in nerve grafting techniques, the use of novel neural conduit materials, timing of facial nerve procedures, and frontiers in experimental nerve grafting techniques are reviewed.

Tissue engineering in facial plastic and reconstructive surgery.

Current biomaterials technology meets some of the needs of the facial plastic and reconstructive surgeon. However, there is a genuine need for improvement in the area of tissue replacement. The principle of tissue engineering provides a natural way to generate needed tissue using the patient's own cells as building blocks, coupled with biodegradable polymers which have been used safely in [figure: see text] patients for decades. This technology enables the creation of complex structures which ultimately have no immunogenicity. Current obstacles to human clinical trials for auricular repair are being pursued for resolution, and the number of new tissues which it may be possible to generate in this fashion continues to expand. Through continued experimentation and collaboration among surgeons, chemical engineers, and materials scientists, we are certain that the barriers to widespread clinical use for this emerging technology will be overcome.