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Original Investigation
Jan/Feb 2019

Association of Regional Facial Dysfunction With Facial Palsy–Related Quality of Life

Author Affiliations
  • 1Facial Nerve Center, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
  • 2Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 3Department of Economics, Econometrics and Finance, University of Groningen, Groningen, the Netherlands
  • 4Department of Plastic and Reconstructive Surgery, Royal Australasian College of Surgeons, University of Sydney, Sydney, Australia
  • 5Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
  • 6Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
JAMA Facial Plast Surg. 2019;21(1):32-37. doi:10.1001/jamafacial.2018.0804
Key Points

Question  Which individual facial grading item contributes most to the estimation of facial palsy–related quality of life?

Findings  In this cohort study of 920 patients with facial palsy, there were 529 with absent synkinesis (flaccid group) and 391 with synkinesis (nonflaccid group). Oral commissure movement with smile was the eFACE item that contributed most in the estimation of facial palsy–related quality of life in groups with facial palsy (relative weight, 0.108 for the flaccid group and 0.025 for the nonflaccid group).

Meaning  The present study demonstrates that the function of individual facial regions is not equally important for the estimation of facial palsy–related quality of life; the ability to smile is of greatest importance in patients with flaccid and nonflaccid facial palsy.

Abstract

Importance  Study of the association of regional facial dysfunction with quality of life will lead to a better understanding of quality of life in facial palsy.

Objective  To determine the association of regional facial dysfunction with facial palsy–related quality of life.

Design, Setting, and Participants  This retrospective cohort analysis included patients with flaccid and nonflaccid (synkinetic) facial palsy treated at a tertiary care facial nerve center; the flaccid facial palsy group included 529 patients, and the nonflaccid facial palsy group included 391 patients. Data were included from all patients with facial palsy who had an eFACE score and Facial Clinimetric Evaluation (FaCE) scale total score acquired at the same time from February 1, 2014, through October 31, 2017. Linear regression analysis was performed to calculate the amount of variance in quality of life explained by the severity of facial palsy (eFACE). A relative weight analysis was performed for the contribution of each individual eFACE item in estimating quality of life.

Main Outcomes and Measures  Facial palsy severity was measured using all 15 individual eFACE items (rated on a scale of 0 to 200, where 0 represents complete flaccidity, 100 represents a balanced aesthetic appearance, and 200 represents the worst imaginable hypertonia of a patient with synkinesis, with a transformation used for values from 101 to 200), and facial palsy–related quality of life was measured using the FaCE scale total score (range, 0 [worst] to 100 [best]).

Results  Data of 920 individual patients (59.5% female; mean [SD] age, 48.6 [16.6] years) were available. The eFACE composite score accounted for 21.2% of the quality-of-life variance in the flaccid group and 13.9% in the nonflaccid group. With the use of all 15 individual eFACE items, these proportions increased to 29.7% and 16.8%, respectively. In both groups, oral commissure movement with smile was found to be the most important contributing item (relative weight, 0.108 [95% CI, 0.075-0.148] for the flaccid group and 0.025 [95% CI, 0.005-0.052] for the nonflaccid group). Items related to the function of periocular muscles were found to be of low importance.

Conclusions and Relevance  The present study suggests that the function of individual facial regions is not equally important for estimating facial palsy–related quality of life. The ability to smile is of greatest importance among patients with flaccid and nonflaccid facial palsy. The true importance of periocular function in the estimation of quality of life should be studied further in future research.

Level of Evidence  NA.

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