Assessment of Emotional Expressions after Full-Face Transplantation

Topçu, Çağdaş; Uysal, Hilmi; Özkan, Ömer; Özkan, Özlenen; Polat, Övünç; Bedeloglu, Merve; Akgül, Arzu Karaman; Döğer, Ela Naz; Sever, Refik; Barçın, Nur Ebru; Tombak, Kadriye; Çolak, Ömer Halil

doi:10.1155/2017/8789724

Cited by 9 publications

(8 citation statements)

References 17 publications

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“…Various methods have quantified motor function recovery, including facial surface electromyography, which found similar high-frequency firing distributions in one-third of patients with full FT as healthy controls during emotional expression testing. 34 Despite providing an objective assessment, widespread adoption is precluded because this modality relies on invasive electrode placement, skilled interpretation, and inability to detect clinically meaningful return of function in patients with FT. 35 Image-based analysis, reporting 45% return of happiness expression after 3 years in two patients with FT, 36 likewise required trained interpretation of results and processed only still frames without capability to assess dynamic function.…”

Section: E Discussionmentioning

confidence: 99%

“…Thus, 13 patients met inclusion criteria (11 male patients; age, 40 ± 14 years); eight received all AUs with full FT and five underwent partial FT receiving AUs of the midface and lower two-thirds of the face (Table 1). 4,7,28,[34][35][36][37][38][39][40] Mean donor allograft and healthy control age were 40 ± 13 years and 41 ± 11 years, respectively (P = 0.933). Mean video follow-up time was 3.6 ± 2.2 years.…”

Section: Study Participant Characteristicsmentioning

confidence: 99%

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“Facial Expression After Face Transplant: The First International Face Transplant Cohort Comparison”

Dorante

Wang

Kollar

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Assessment of motor function restoration following face transplant (FT) is difficult, as standardized, bilateral tests are lacking. This study aims to bolster support for software-based analysis through international collaboration. Methods: FaceReader (Noldus, Wageningen, The Netherlands), a facial expression analysis software, was used to analyze posttransplant videos of eight FT patients from Boston, Massachusetts (range, 1 to 9 years after transplant), two FT patients from Helsinki, Finland (range, 3 to 4 years after transplant), and three FT patients from Antalya, Turkey (range, 6.5 to 8.5 years after transplant). Age-matched healthy controls from respective countries had no history of prior facial procedures. Videos contained patients and controls performing facial expressions evaluated by software analysis using the Facial Action Coding System. Facial movements were assigned intensity score values between 0 (absent) and 1 (fully present). Maximum values were compared with respective healthy controls to calculate percentage restoration. Results: Of 13 FT patients, eight patients were full FT, five patients were partial FT, and two patients were female patients. Compared with healthy controls, the median restoration of motor function was 36.9% (interquartile range, 28.8% to 52.9%) for all patients with FT (P = 0.151). The median restoration of smile was 37.2% (interquartile range, 31.5% to 52.7%) for all patients with FT (P = 0.065). When facial nerve coaptation was performed at the distal branch level, average motor function restoration was 42.7% ± 3.61% compared with 27.9% ± 6.71% at the proximal trunk coaptation level (P = 0.032). Use of interpositional nerve grafts had no influence on motor outcomes. Conclusions: Software-based analysis is suitable to assess motor function after FT. International collaboration strengthens outcome data for FT. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Section: E Discussionmentioning

confidence: 99%

Section: Study Participant Characteristicsmentioning

confidence: 99%

“Facial Expression After Face Transplant: The First International Face Transplant Cohort Comparison”

Dorante

Wang

Kollar

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…Some studies have attempted to measure emotional expression after face transplant. Topçu et al 15 found that the frequency and spatial distribution of facial surface electromyography data recorded during emotional expression were significantly different between patients with face transplants and healthy controls after 2 years. One of their 3 patients with full face transplants had high-frequency firing distribution similar to that of healthy controls for happiness, whereas other expressions had similar distribution patterns but lower frequency.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14] Despite their high relevance, limited quantitative data are available on the restoration of facial emotional expression after face transplant. Existing evidence comes from methods such as facial surface electromyography, 15 which is sensitive but requires painstaking placement of several electrodes on the skin, 16 and appearance-based facial feature extraction, which is similar to facial recognition technology but requires significant data processing that limits reproducibility. 17 These methods are obtrusive and prone to human instrumentation error.…”

Section: Introductionmentioning

confidence: 99%

Recognizing Emotional Expression as an Outcome Measure After Face Transplant

et al. 2020

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IMPORTANCE Limited quantitative data exist on the restoration of nonverbal communication via facial emotional expression after face transplant. Objective and noninvasive methods for measuring outcomes and tracking rehabilitation after face transplant are lacking. OBJECTIVE To measure emotional expression as an indicator of functional outcomes and rehabilitation after face transplant via objective, noninvasive, and nonobtrusive software-based video analysis. DESIGN, SETTING, AND PARTICIPANTS This single-center case-control study analyzed videos with commercially available video analysis software capable of detecting emotional expression. The study participants were 6 patients who underwent face transplant at Brigham and Women's Hospital between April 2009 and March 2014. They were matched by age, race/ethnicity, culture, and sex to 6 healthy controls with no prior facial surgical procedures. Participants were asked to perform either emotional expressions (direct evaluation) or standardized facial movements (indirect evaluation). Videos were obtained in a clinical setting, except for direct evaluation videos of 3 patients that were recorded at the patients' residences. Data analysis was performed from June 2018 to November 2018. MAIN OUTCOMES AND MEASURES The possibility of detecting the emotional expressions of happiness, sadness, anger, fear, surprise, and disgust was evaluated using intensity score values between 0 and 1, representing expressions that are absent or fully present, respectively. RESULTS Six patients underwent face transplant (4 men; mean [SD] age, 42 [14] years). Four underwent full face transplants, and 2 underwent partial face transplants of the middle and lower two-thirds of the face. In healthy controls, happiness was the only emotion reliably recognized in both indirect (mean [SD] intensity score, 0.92 [0.05]) and direct (mean [SD] intensity score, 0.91 [0.04]) evaluation. Indirect evaluation showed that expression of happiness significantly improved 1 year after transplant (0.04 point per year; 95% CI, 0.02 to 0.06 point per year; P = .002). Expression of happiness was restored to a mean of 43% (range, 14% to 75%) of that of healthy controls after face transplant. The expression of sadness showed a significant change only during the first year after transplant (−0.53 point per year; 95% CI, −0.82 to −0.24 point per year; P = .005). All other emotions were detectable with no significant change after transplant. Nearly all emotions were detectable in long-term direct evaluation of 3 patients, with expression of happiness restored to a mean of 26% (range, 5% to 59%) of that of healthy controls. CONCLUSIONS AND RELEVANCE Partial restoration of facial emotional expression is possible after face transplant. Video analysis software may provide useful clinical information and aid rehabilitation after face transplant.

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“…Primary motor and sensory innervations of the transplanted faces of individuals are usually complete within 9 months (Topçu et al, 2017). However, this course involves the loss of face tissue, as the muscle and skin innervation of the face tissue undergoes the process of total denervation and reinnervation (Özkan et al, 2017; Siemionow et al, 2011a).…”

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confidence: 99%

Complementary Phenomena: Phantom Hand and Phantom Face

Uysal

Şavkliyildiz

Özkan

et al. 2021

Cognitive and Behavioral Neurology

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After tissue or limb loss, the development of sensation and perception of the lost or deafferent tissue is defined as a phantom phenomenon. We investigated the presence of phantom phenomena in individuals who underwent a full face transplant as well as those who had a hand transplant. Specifically, we investigated sensory perception of the face on the fingers and sensory perception of the fingers on the face in three full face and four hand transplant patients. In all seven individuals, we used a brush to separately stimulate the right and left sides of the face or the palmar and dorsal faces of the hand. We then asked the individuals if they felt a sensation of touch on any other part of their body and, if so, to describe their perceptions. Changes in the regions of the primary sensory cortex representing the hand and face were defined using fMRI obtained via tactile sensory stimulation of the clinical examination areas. Two of the full face transplant patients reported sensory perceptions such as a prominent sensation of touch on their faces during sensory stimulation of their fingers. Three of the hand transplant patients reported sensory perceptions, which we referred to as finger patches, during sensory stimulation of the face area. In fMRI, overlaps were observed in the cortical hand and face representation areas. We consider the phantom hand and phantom face phenomena we observed to be complementary due to the neighborhood of the representations of the hand and face in the somatosensory cortex.

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Assessment of Emotional Expressions after Full-Face Transplantation

Cited by 9 publications

References 17 publications

“Facial Expression After Face Transplant: The First International Face Transplant Cohort Comparison”

“Facial Expression After Face Transplant: The First International Face Transplant Cohort Comparison”

Recognizing Emotional Expression as an Outcome Measure After Face Transplant

Complementary Phenomena: Phantom Hand and Phantom Face

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