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Original Investigation
January 26, 2017

Photographic Standards for Patients With Facial Palsy and Recommendations by Members of the Sir Charles Bell Society

Author Affiliations
  • 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
  • 2Facial Nerve Programme, Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children’s National Health Service Foundation Trust, Liverpool, England
  • 3Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
  • 4Facial Nerve Center, Division of Facial and Plastic and Reconstructive Surgery, Department of Otology and Laryngology, Harvard Medical School and Massachusetts Eye and Ear, Boston
  • 5Facial Nerve Institute, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
JAMA Facial Plast Surg. Published online January 26, 2017. doi:10.1001/jamafacial.2016.1883
Key Points

Question  How do clinicians specializing in facial paralysis use photography and videography to document facial nerve function in this special patient population?

Findings  A cross-sectional survey of the Sir Charles Bell Society members, a group of professionals dedicated to caring for patients with facial palsy, revealed that all members used some form of photography to document outcomes; however, there was variability in which facial expressions were used.

Meaning  There is no consensus on photographic standardization to report outcomes for patients with facial palsy; therefore, we propose minimum photographic standards for facial paralysis publications to improve exchange of information and comparison of outcomes.

Abstract

Importance  There is no widely accepted assessment tool or common language used by clinicians caring for patients with facial palsy, making exchange of information challenging. Standardized photography may represent such a language and is imperative for precise exchange of information and comparison of outcomes in this special patient population.

Objectives  To review the literature to evaluate the use of facial photography in the management of patients with facial palsy and to examine the use of photography in documenting facial nerve function among members of the Sir Charles Bell Society—a group of medical professionals dedicated to care of patients with facial palsy.

Design, Setting, and Participants  A literature search was performed to review photographic standards in patients with facial palsy. In addition, a cross-sectional survey of members of the Sir Charles Bell Society was conducted to examine use of medical photography in documenting facial nerve function. The literature search and analysis was performed in August and September 2015, and the survey was conducted in August and September 2013.

Main Outcomes and Measures  The literature review searched EMBASE, CINAHL, and MEDLINE databases from inception of each database through September 2015. Additional studies were identified by scanning references from relevant studies. Only English-language articles were eligible for inclusion. Articles that discussed patients with facial palsy and outlined photographic guidelines for this patient population were included in the study. The survey was disseminated to the Sir Charles Bell Society members in electronic form. It consisted of 10 questions related to facial grading scales, patient-reported outcome measures, other psychological assessment tools, and photographic and videographic recordings.

Results  In total, 393 articles were identified in the literature search, 7 of which fit the inclusion criteria. Six of the 7 articles discussed or proposed views specific to patients with facial palsy. However, none of the articles specifically focused on photographic standards for the population with facial palsy. Eighty-three of 151 members (55%) of the Sir Charles Bell Society responded to the survey. All survey respondents used photographic documentation, but there was variability in which facial expressions were used. Eighty-two percent (68 of 83) used some form of videography. From these data, we propose a set of minimum photographic standards for patients with facial palsy, including the following 10 static views: at rest or repose, small closed-mouth smile, large smile showing teeth, elevation of eyebrows, closure of eyes gently, closure of eyes tightly, puckering of lips, showing bottom teeth, snarling or wrinkling of the nose, and nasal base view.

Conclusions and Relevance  There is no consensus on photographic standardization to report outcomes for patients with facial palsy. Minimum photographic standards for facial paralysis publications are proposed. Videography of the dynamic movements of these views should also be recorded.

Level of Evidence  NA.

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