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Invited Commentary
February 13, 2020

Beyond the Lost Smile—Exploring Individual-Specific Facets of Facial Paralysis

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, Washington University in St Louis, St Louis, Missouri
  • 2Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Washington University in St Louis, St. Louis, Missouri
JAMA Otolaryngol Head Neck Surg. 2020;146(4):337-338. doi:10.1001/jamaoto.2019.4560

The face is a critical conduit through which humans interact with the world and one another. Facial paralysis presents a unique situation in which quality of life is altered by self-perception and societal impression because it is so visible and touches on the essential features of human interaction, including nonverbal cues and verbal speech. The role of facial paralysis in quality of life has been explored in the scientific literature. Patients with facial paralysis have lower scores for disease-specific quality of life, higher scores for depression, reduced self-reported attractiveness, and lower mood scores compared with patients without facial paralysis.1,2 The societal repercussions of facial disfigurement are substantial. A study of casual, healthy observers found that the participants were willing to pay upward of $20 000 out-of-pocket for facial reanimation surgery if they had severe facial paralysis.3 Although efforts to standardize the physical assessment of facial paralysis have evolved—from House-Brackmann to electronic clinician-graded facial function scale (eFaCE) to the computerized Emotrics—no correlation exists between physician assessment of facial paralysis severity and patient quality of life.2,4 Increasingly, there has been burgeoning interest in understanding the specific reasons behind the social and quality-of-life disadvantages of individuals with facial paralysis.1 The question of what specific factors influence quality of life is best answered by the patients who actually have facial paralysis.

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