Societal Value of Surgery for Facial Reanimation

Abstract

IMPORTANCEPatients with facial paralysis are perceived negatively by society in a number of domains. Society's perception of the health utility of varying degrees of facial paralysis and the value society places on reconstructive surgery for facial reanimation need to be quantified.OBJECTIVE To measure health state utility of varying degrees of facial paralysis, willingness to pay (WTP) for a repair, and the subsequent value of facial reanimation surgery as perceived by society. DESIGN, SETTING, AND PARTICIPANTSThis prospective observational study conducted in an academic tertiary referral center evaluated a group of 348 casual observers who viewed images of faces with unilateral facial paralysis of 3 severity levels (low, medium, and high) categorized by House-Brackmann grade. Structural equation modeling was performed to understand associations among health utility metrics, WTP, and facial perception domains. Data were collected from July 16 to September 26, 2015.MAIN OUTCOMES AND MEASURES Observer-rated (1) quality of life (QOL) using established health utility metrics (standard gamble, time trade-off, and a visual analog scale) and ( 2) their WTP for surgical repair. RESULTS Among the 348 observers (248 women [71.3%]; 100 men [28.7%]; mean [SD] age, 29.3 [11.6] years), mixed-effects linear regression showed that WTP increased nonlinearly with increasing severity of paralysis.

Lower Lip Reanimation: Experience Using the Anterior Belly of Digastric Muscle in 2-stage Procedure

“…As such, many techniques have evolved to treat facial paralysis. 1 These strive for symmetry in repose, voluntary movement, and spontaneous expression, but focus predominantly on upper lip and smile restoration. 2 , 3 Functioning lower lip depressors are also important, not just for a full denture smile, but for subtle movement of lower lip and phonetics in everyday conversation.…”

The health utility of mild and severe dysphonia

“…Given the exponentially increasing costs of medical care in the United States and abroad, there has been growing interest in evaluating health utility across medical specialties . Health utility values have been measured for a variety of conditions within otolaryngology, including head and neck cancer, facial paralysis, hearing loss, and chronic rhinosinusitis . Within laryngology, where surgical therapies often affect quality of life rather than life span, there is increasing focus on assessing the cost‐effectiveness of laryngeal surgery .…”

The spectrum of facial palsy: The MEEI facial palsy photo and video standard set

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