Psychometric Validation of the FACE-Q Craniofacial Module for Facial Nerve Paralysis.

Background: Systematic reviews have identified the need for a patient-reported outcome measure for facial nerve paralysis (FNP). The aim of this study was to determine the psychometric properties of FACE-Q Craniofacial module scales when used in a combined sample of children and older adults with FNP. Methods: Data were collected between December 2016 and December 2019. We conducted qualitative interviews with children and adults with FNP. FACE-Q data were collected from patients aged 8 years and older with FNP. Rasch measurement theory analysis was used to examine the reliability and validity of the relevant scales in the FNP sample. Results: Twenty-five patients provided 2052 qualitative codes related to appearance, physical, psychological, and social function. Many patient concerns were common across age. The field-test sample included 235 patients aged 8-81 years. Of the 13 scales examined, all 122 items had ordered thresholds and good item fit to the Rasch model. For 12 scales, person separation index values were ≥0.79 and Cronbach's alpha values were ≥0.82. The 13th scale's reliability values were ≥0.71. Conclusion: The FACE-Q Craniofacial module scales described in this study can be used to collect and compare evidence-based outcome data from children and adults with FNP.

[Congenital facial palsy].

Congenital facial palsy is unilateral or bilateral facial nerve palsy at birth due to genetic or different pathogenic factors. It can be divided into syndromic type and non-syndromic type according to its accompanying symptom. The pathogeny and symptom of each type are different, in part with genetic heterogeneity. Congenital facial palsy cannot recover spontaneously. Different types of congenital facial palsy have different treatment schemes. The treatment is significant to the improvement of life quality and physical and mental development of children with congenital facial palsy.

Development of the Alberta facial clinical evaluation scale: A patient-centred outcomes instrument for facial nerve paralysis.

OBJECTIVES: Facial nerve paralysis has functional, psychological and social consequences for patients. Traditionally, outcome measurements for facial nerve injuries have been clinician derived. Recent literature has shown that patient perspective is valuable and necessary in outcomes research. This study aimed to identify patient domains of concern and subsequently, develop a point-of-care questionnaire for clinical use. DESIGN: This mixed-methods prospective study was completed in three phases. In Phase I, 15 facial nerve injury patients were interviewed individually. Interviews were digitally recorded, transcribed and coded with NVivo software. Analysis led to a conceptual framework detailing the most important quality of life outcomes. During Phase II, a focus group was held with five new patients in order to prioritise the outcome themes to a top six list. A second focus group was held with Otolaryngology-Head and Neck staff surgeons to create a 25-item questionnaire based on these six themes. In Phase III, the questionnaire was administered to 10 new patients to test for comprehension. SETTING: University of Alberta Hospital, Edmonton, Alberta, Canada. PARTICIPANTS: A total of 30 patients with facial nerve injury were included in the various phases in the study. In addition, 5 staff Otolaryngology-Head and Neck surgeons participated as focus group contributors. MAIN OUTCOME MEASURES: Domains of concern and quality of life outcomes as reported by facial nerve injury patients. RESULTS: Patients identified a total of 16 themes encompassing both functional and psychological deficits related to their facial nerve injury. From these findings, a 25-item Likert-type scale, the A-FaCE scale, was developed for clinical use. CONCLUSIONS: Patients with facial nerve paralysis experience functional and psychological deficits. This study led to the creation of the first patient-reported instrument for this population that addresses functional impairment, social function, psychological well-being and self-perception of appearance.

Effectiveness of a multidisciplinary facial function clinic.

OBJECTIVES: To analyse the usefulness of a multidisciplinary facial function clinic (FFC). DESIGN: Retrospective case-note review. SETTING: The FFC was established in July 2006 at the Manchester Royal Eye Hospital with attending consultants from Ophthalmology, Skull-Base Otolaryngology, Plastic Surgery, and Physiotherapy. PARTICIPANTS: We retrospectively reviewed the case notes for 59 consecutive patients seen at the FFC from July 2006 to February 2009. MAIN OUTCOME MEASURES: We documented demographic data, including distance travelled and average journey time. RESULTS: The 59 patients (mean age 46 years) made a total of 106 clinical visits (mean 1.8). The mean distance travelled by a patient was 31.9 miles with an estimated journey time of 47 min, each way. At presentation the average House-Brackmann grade of facial nerve weakness was IV. Ophthalmologist's advice was needed for 58 (98.3%), otolaryngologist's for 57 (96.6%), plastic surgeon for 49 (83.0%), physiotherapist for 58 (98.3%), and 4 (6.8%) were referred for psychological counselling. In all, 47 (79.7%) of our patients needed input from all four consultants during their visit at the FFC. By combining the presence of several consultants in one clinic, we saved an average of 5.1 visits (325.4 miles; 8 h travel time) for each patient. CONCLUSION: We and our patients feel our multidisciplinary facial function clinic has been an effective service and has continued to work.

Language abilities and gestural communication in a girl with bilateral perisylvian syndrome: a clinical and rehabilitative follow-up.

We present the neuropsychological and linguistic follow-up of a girl with bilateral perisylvian polymicrogyria during 4 years of gestural and verbal speech therapy. Some researchers have suggested that children with bilateral perisylvian polymicrogyria mentally fail to reach the syntactic phase and do not acquire a productive morphology. This patient achieved a mean length of utterance in signs/gestures of 3.4, a syntactic phase of completion of the nuclear sentence and the use of morphological modifications. We discuss the link between gesture and language and formulate hypotheses on the role of gestural input on the reorganization of compensatory synaptic circuits.

Quality of life after facial nerve repair.

OBJECTIVES: Analyze the postoperative quality of life (QoL) in patients after surgical nerve repair for facial nerve lesion. STUDY DESIGN: Descriptive study using questionnaire data and medical chart review. METHODS: Forty-nine patients answered the Short Form-36 (SF-36), the European Organization for Research and Treatment (EORTC) questionnaires QLQ-C30 and QLQ-HN35, and a modification of the Acoustic Neuroma Hospital of Norway Survey. Facial function was self-evaluated by the patients using the House-Brackmann (HB) scale and the Stennert index (SI). The questionnaire data were analyzed in relation to the medical chart data. RESULTS: The follow-up time ranged from 12 to 202 months. The underlying disease was benign in 34 (61%) patients and malignant in 15 (39%) patients. Facial nerve repair was successful in all patients, with a mean HB scale of 3.1, a mean SI of 4.9, and a mean May grading of 2.7. The facial function self-evaluation was not significantly different. Seventy-five percent of the patients were satisfied with the operation. The SF-36 demonstrated a significantly lower social functioning, emotional role, general mental health, and vitality lower than in the normal German population. In the EORTC QLQ C30, emotional function was low and the insomnia rate high. EORTC QLQ HN35 showed a high rate of trouble with social eating, less sexuality, problems opening mouth, and weight gain problems. Age 45 years or older, female sex, May grading 3 or greater, SI self-assessment 5 or greater, HB self-assessment greater than 2 had a significant negative effect on some QoL items, but not factors such as type or histology of the disease or delayed reconstruction. CONCLUSIONS: Although grading of facial function after nerve repair revealed satisfying results, the patients experience a reduced QoL.

Importance of facial expression in facial nerve rehabilitation.

PURPOSE OF REVIEW: This review discusses contemporary evidence for the importance of facial expression to human beings. Strategies for management of patients with facial nerve dysfunction are discussed. RECENT FINDINGS: The purpose of facial expression from a cognitive neuroscience perspective has become clearer, including its role in emotional communication and identification. Facial retraining may have a role in rehabilitation. SUMMARY: Greater awareness of the biologic basis for facial expression may lead us to pay increased attention to evaluation and treatment of this component of facial nerve dysfunction. The timing of intervention remains important, and many effective techniques exist.

Specific impairment of smiling increases the severity of depressive symptoms in patients with facial neuromuscular disorders.

Depressive symptoms and related emotional distress are prevalent among patients with facial neuromuscular disorders, and the psychological distress impacts the functional disabilities associated with the facial impairment. A specific impairment in the ability to smile may elevate the risk for depression, with patients experiencing a reduced physiological feedback associated with smiling as well as the social consequences of the inability to communicate positive emotion. We tested the hypothesis that specific impairments in the ability to smile increase the severity of depressive symptoms in patients with facial neuromuscular disorders. Twenty-nine consecutive patients (mean age, 50.2 years; SD, 17.0 years; range, 18-81 years) with a facial neuromuscular disorder, who volunteered and completed all of the assessment measures participated. Facial neuromuscular impairments were assessed using multiple measures of facial motility and dysfunction, and emotional functioning was assessed using self-report measures of depression, anxiety, and positive and negative affect. Severity of global facial impairment was statistically controlled in evaluating the association between specific impairment in smiling and the degree of depressive symptoms. Separate hierarchical linear regression analyses indicated the specific impairment of smiling contributed to the prediction of depression (R(2) =.41, df = 3,25, p =.00) and anxiety (R(2) =.35, df = 3,25, p =.00), controlling first for the contribution of global impairment and facial physical disability. The specific impairment of smiling did not contribute to the prediction of positive emotional experience. Specific impairment of smiling and physical disability, but not global impairment of facial motion, were key predictors of depression in patients with facial neuromuscular disorders. The results emphasize the need to assess and treat depression and anxiety in patients with a facial neuromuscular disorder.

Psychological distress: linking impairment with disability in facial neuromotor disorders.

The relationship between facial neuromotor system impairment, disability, and psychological adjustment is not well understood. This study was designed to explore the relation between impairment and disability and the impact of psychological adjustment on the relation for individuals with disorders of the facial neuromotor system. We studied outpatients (n=48; mean age, 49.0; SD=16.3; range, 18 to 84 years) with a facial neuromotor disorder and acute or chronic facial paralysis. Measures of impairment (Facial Motion Assay, House-Brackmann scale, and Facial Grading System), disability (Facial Disability Index, physical and social well-being subscales), and psychological adjustment (Beck Anxiety Inventory, Beck Depression Inventory) were administered. Bivariate correlations between impairment and disability measures indicated impairment was positively correlated with physical and social disability (r=0.44, p < 0.01; r=0.39, p < 0.05, respectively). Stepwise regression analysis to predict disability indicated physical disability was predicted by impairment and the interaction of impairment and psychological distress (R2=0.425; F=12.57; df=2, 34; p=0.002). Psychological distress, and not impairment and the interaction of impairment and distress, was the single predictor of social disability (R2=0.274; F=13.23; df=1, 35; p=0.001). Psychological distress was a moderator of the relation between impairment and physical disability and a mediator of the relation between impairment and social disability for individuals with facial neuromotor disorders. Assessment and interventions targeted for psychological distress in addition to interventions targeted for impairments appear warranted to effectively reduce the disability associated with facial neuromotor disorders.