Patients with facial paralysis have an obvious facial disability including facial disfigurement and impairment in soft tissue movements, particularly in facial expressive behaviors. These negative physical sequelae not only impact facial esthetics and function, but also patients' social and emotional quality of life (QOL). Treatments range from non-surgical interventions and facial reanimation surgery to new implantable facial pacing devices that would potentially initiate artificial movement on the paralyzed side of the face. Traditionally, surgeons' plan treatment based on isolated measurements made from 2D photographs and subjective grading of the patient's face, both of which are limited in scope and dimension. Our research has demonstrated the utility of novel, landmark-based, 3D dynamic and static quantitative (objective) measures for the evaluation of facial soft tissue function (NIH DE 013814, DE 016964, and DE 013814-08S1). These measures have been validated for use in the cleft lip/palate (CL/P) patient population. The measures are objective and quantitative. They provide a more precise diagnosis of facial soft tissue disability and evaluation of surgical outcomes. The main goal of this prospective, observational study is to determine the applicability of these novel 3D dynamic and static measures for quantification and measurement of impairment and disfigurement, as well as change over time, in patients with facial paralysis. We will also explore the utility of non-landmark based dynamic and static measures. The global research question is whether the use of the measures will provide a more comprehensive analysis of the severity of facial paralysis and the changes over time (recovery) when compared with current assessment methods.
The specific aims of the study are:
Specific Aim 1. To quantitatively evaluate the range of facial soft tissue disability (facial impairment and disfigurement) in patients with acute, unilateral, flaccid facial paralysis and track the changes over time (3 month recovery period), and to compare the facial disability in the patients with a group of age- and sex-frequency matched normal subjects.
Specific Aim 2. In patients with acute unilateral, flaccid facial paralysis, to compare the current qualitative clinical assessment methods for facial impairment and disfigurement (House-Brackman Facial Nerve Grading System & Sunnybrook Facial Grading System ) with the objective quantitative assessments in order to assess the differential information provided by a quantitative zonal analysis versus a qualitative global assessment.
Specific Aim 3. (a) To assess perceptions of facial appearance and QOL over time in patients with acute, unilateral, flaccid facial paralysis and to compare these perceptions with those of control subjects, and (b) To correlate the patients' perceptions over time with the quantitative measures of facial disability. Ultimately, this study is unique for the rehabilitation of patients with facial paralysis in that the focus is on generating novel, objective, 3D measures to characterize the condition and temporal changes, and on the generation of future hypotheses to optimize interventions and assess the outcomes of the different treatments.
Facial paralysis in the United States affects approximately 100,000 new patients per year with an estimated annual health care cost of two billion dollars. Patients remain with severe facial soft tissue disability that includes impairments in movements, particularly facial expressive behaviors. We have demonstrated the utility of novel 3D dynamic and static quantitative (objective) measures that were validated for use in the cleft lip/palate patient population, and which provide a more precise diagnosis of the facial disability and evaluation of surgical outcomes. Thus, the main goal of this prospective, observational study is to determine the applicability of these novel 3D dynamic and static measures for quantification and measurement of impairment and disfigurement, as well as change over time, in patients with facial paralysis. Ultimately, we will generate novel, objective measures to characterize the condition and temporal changes, and generate future hypotheses to optimize interventions and assess the outcomes of the different treatments.
|Trotman, Carroll Ann; Faraway, Julian; Hadlock, Tessa et al. (2018) Facial Soft-tissue Mobility: Baseline Dynamics of Patients with Unilateral Facial Paralysis. Plast Reconstr Surg Glob Open 6:e1955|
|Trotman, Carroll Ann; Faraway, Julian; Hadlock, Tessa et al. (2018) Quantifying Soft Tissue Shape and Symmetry: Patients with Cleft Lip/Palate and Facial Paralysis. Plast Reconstr Surg Glob Open 6:e1715|