Optimizing Total Facial Nerve Patient Management for Effective Clinical Outcomes Research

Abstract

ver the past several decades, clinical outcomes research in facial paralysis has been hampered by a lack of objective and quantitative evaluation of facial function. Ideally, a standard and systematic model for evaluating patient outcomes would exist for patients with facial paralysis. Such a model has been generically described in a recent Outcomes Measure Framework whitepaper 1 for the Agency for Healthcare Research and Quality and was adapted for use in facial plastic surgery and facial paralysis. The components of this model include characteristics of the patient, features of their facial paralysis, and treating health care providers. In addition, the elements of treatment, including types and intent, and their outcomes are recorded. Effective evaluation of facial outcomes following treatment requires both clinician-reported and patient-reported measures of function and well-being. Clinician-reported scales, such as the Sunnybrook Facial Grading System 2 and the modified House-Brackmann grading scale, 3 provide one necessary component of evaluation. Similarly, validated software tools (Facial Assessment by Computer Evaluation program [FACE-gram]) 4 for evaluating facial movement from images also exist and play an important role in treatment planning and assessment. 5 Finally, several relevant patient-reported outcomes measures now exist for facial paralysis such as the Facial Clinimetric Evaluation (FaCE) Scale, 6 the NOSE Scale, 7 and the Synkinesis Assessment Questionnaire. 8 Moving from model to implementation requires the development of both processes and technology to collect, manage, and interpret data. At the Massachusetts Eye and Ear Infirmary (MEEI), we have treated over 2000 patients with facial nerve injury since 2002. To better quantify and improve our outcomes, we have over the years developed what we now believe represents a systematic method for the previsit evaluation, intake, management, and follow-up of our patients with facial nerve injury to optimize data collection for the purposes of clinical studies. However, because standard and systematic data collection for many clinical entities has only recently been introduced, statistically valid conclusions will arise from analysis of data over IMPORTANCE Assessment of outcomes in patients with facial paralysis is challenging owing to the lack of objective tools to evaluate facial function and suboptimal data collection. OBJECTIVE To describe a methodology for prospective evaluation of patients with facial paralysis that permits optimal assessment of clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS At the Massachusetts Eye and Ear Infirmary, we have treated over 2000 patients with facial nerve injury since 2002. To better quantify and improve our outcomes, we have developed what we now believe represents a systematic method for the previsit evaluation, intake, management, and follow-up of our facial nerve patients to optimize data collection for the purposes of clinical outcome studies, as detailed in this retrospective descriptive study. RE...

Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center

“…Because it is relatively rare for masses to present with acute FP, we do not recommend imaging as part of the initial evaluation for patients whose history is otherwise consistent with BP. A thorough history and physical examination that evaluates the cranial nerves, lymph nodes, parotid glands, ears, and facial skin will often elucidate the presence of a malignancy; however, if no sign of recovery is apparent within 4 months of onset, the presence of a tumor should be considered even in the context of an otherwise unremarkable history and physical examination …”

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

“…Similarly, another view substantially underused by survey respondents and absent from our literature review was the nasal base view, which has also been discussed by Bhama and colleagues. 8 This view is especially important to assess symmetry of the external valve. Nasal obstruction is a common but underrecognized problem among patients with facial palsy, and static or dynamic support of the external nasal valve can improve patients’ perception of nasal airflow.…”

“…This requirement would improve exchange of information and may assist with execution of high-quality, multicenter studies needed in this patient population. 8 …”

Reliability of grading of facial palsy using a video tutorial with synchronous video recording

“…Standardized grading is essential for the initial, follow‐up, and outcome assessment of patients with FP . Typically, the grading is performed by the therapist while sitting in front of the patient or is performed later based on photographic or video documentation.…”

“…It has been demanded to take standardized photography series and videos, including the face at rest and with attempts to perform a set of important mimic functions (e.g., eye closure, smiling, pursing the lips, brow raising) . This documentation should be repeated at regular intervals after initiation of therapy and be part of the outcome assessment . However, there still is no consensus on the sequence of photographic and video documentation required for patients with FP.…”