Use of Objective Metrics in Dynamic Facial Reanimation

Abstract

IMPORTANCE Facial nerve deficits cause significant functional and social consequences for those affected. Existing techniques for dynamic restoration of facial nerve function are imperfect and result in a wide variety of outcomes. Currently, there is no standard objective instrument for facial movement as it relates to restorative techniques. OBJECTIVETo determine what objective instruments of midface movement are used in outcome measurements for patients treated with dynamic methods for facial paralysis.DATA SOURCES Database searches from January 1970 to June 2017 were performed in PubMed, Embase, Cochrane Library, Web of Science, and Scopus. Only English-language articles on studies performed in humans were considered. The search terms used were ("Surgical Flaps"[Mesh] OR "Nerve Transfer"[Mesh] OR "nerve graft" OR "nerve grafts") AND (face [mh] OR facial paralysis [mh]) AND (innervation [sh]) OR ("Face"[Mesh] OR facial paralysis [mh]) AND (reanimation [tiab]).STUDY SELECTION Two independent reviewers evaluated the titles and abstracts of all articles and included those that reported objective outcomes of a surgical technique in at least 2 patients. MAIN OUTCOMES AND MEASURESThe presence or absence of an objective instrument for evaluating outcomes of midface reanimation. Additional outcome measures were reproducibility of the test, reporting of symmetry, measurement of multiple variables, and test validity. RESULTSOf 241 articles describing dynamic facial reanimation techniques, 49 (20.3%) reported objective outcome measures for 1898 patients. Of those articles reporting objective measures, there were 29 different instruments, only 3 of which reported all outcome measures. CONCLUSIONS AND RELEVANCEAlthough instruments are available to objectively measure facial movement after reanimation techniques, most studies do not report objective outcomes. Of objective facial reanimation instruments, few are reproducible and able to measure symmetry and multiple data points. To accurately compare objective outcomes in facial reanimation, a reproducible, objective, and universally applied instrument is needed.

Quantified analysis of facial movement: A reference for clinical applications

“…In many fields of medicine, technological progress has enabled accurate diagnoses and personalized treatments. In this respect, several researchers have contributed to our understanding of facial movements (Samsudin & Sundaraj, 2014; Griffin & Kim, 2012; Lee et al, 2015; Popat et al, 2009; Revenaugh et al, 2018) by investigating facial biomechanics and disease‐related changes in facial mobility. Following on from these literature data, our present study of a cohort of healthy adults was one of the most exhaustive to date (Sforza, Galante, et al, 2010; Sforza, Mapelli, et al, 2010; Trotman et al, 2018).…”

“…Most are based on a qualitative description of movements (e.g., the House‐Brackmann facial nerve grading system [House, 1983] and the Sunnybrook facial grading system [Ross et al, 1996]) or manual muscle testing (Freyss et al, 1971). However, these grading systems are based on subjective, poorly reproducible clinical observations that introduce bias (Gaudin et al, 2016; Popat et al, 2009) in routine use or during the long‐term follow‐up of patients with persistent sequelae (Fattah et al, 2015; Revenaugh et al, 2018; Scheller et al, 2017).…”

Effect of Distal Masseter to Facial Nerve Transfer in Paralytic Patients with Preserved Facial Nerve Continuity on Improving Scaled Measurement of Improvement in Lip Excursion (SMILE): A Vectoral Analysis

“…Many evaluation systems were introduced in the late 1990s, and there has been a focus on the use of objective metrics in dynamic facial reanimation (19)(20)(21)(22)(23). In 2000s, computer analysis software have been used to analyze facial movements (20)(21)(22).…”

Comparative analysis of the nerve transfer methodologies used during surgical treatment of peripheral facial paresis

“…The efficacy of the administered treatments is assessed via a set of clinical parameters; however, we are currently limited in our ability to use digitalization of the evaluation of facial muscle motor activity or electroneuromyography to induce objectivity [12]; nonetheless, the most state-of-the-art methods, do employ three-dimensional monitoring of facial movements [13]. It can be stated, in a general manner that a differentiated approach, including the use of combined treatment methods, improves the patient's quality of life.…”