Normal Facial Function in the Sunnybrook Facial Grading System: Is the 100% Score too Restrictive?

OBJECTIVES: The primary objective of this study was to describe the distribution of the Sunnybrook Facial Grading System scores in the general population. Secondary objectives included analyzing the effects of age, gender and facial side on these scores. DESIGN: Two speech therapists specializing in facial motor skill assessment evaluated the healthy participants using the Sunnybrook Facial Grading System, first with the right hemiface as a reference and then with the left hemiface as a reference. SETTING: The study was conducted in our ENT department from September 2022 to June 2023. PARTICIPANTS: One hundred eleven healthy participants were included (57 women and 54 men), aged 18 to 79 years. MAIN OUTCOME MEASURES: SFGS composite scores (SFGS-Total) and sub-scores at rest (SFGS-Rest) and in movement (SFGS-Movement) were studied according to three age categories (18-39 years) (40-59 years) and (60-79 years) and gender. Inter-rater reliability was collected between the two evaluators with Cronbach's alpha. RESULTS: Taking the right hemiface as a reference, SFGS-Total scores ranged from 65% to 100% (median = 96, IQR [91-100]). When the left hemiface was considered as the reference, scores ranged from 78% to 100% (median = 95; IQR [90-100]). Right and left SFGS-Total scores showed high inter-rater reliability (respectively α = 0.953 and α = 0.926). There was a slight negative correlation between age and SFGS-Total scores. CONCLUSIONS: By embracing a more realistic approach that acknowledges natural variations and asymmetry in facial movements, we can enhance patient care and promote a more holistic understanding of facial rehabilitation outcomes.

Impact of Botulinum Toxin Injections on Quality of Life of Patients with Long-Standing Peripheral Facial Palsy.

(1) Background: Sequels of facial palsy lead to major psychosocial repercussions, disrupting patients' quality of life (QoL). Botulinum toxin (BoNT) injections can permit us to treat long-standing facial palsy, improving facial symmetry and functional signs including synkinesis and contractures. (2) Methods: The main aim of this study was to assess the evolution of the QoL for patients with long-standing facial palsy before, at 1 month, and at 4 months after BoNT injections by using three questionnaires (HFS-30, FaCE, and HAD). The other goals were to find clinical factors associated with the improvement in the QoL and to assess the HFS-30 questionnaire for patients with unilateral facial palsy (3) Results: Eighty-eight patients were included in this study. There was a statistically significant improvement in QoL at 1 month after injections, assessed using the three questionnaires. This improvement was sustained at 4 months after the injections, with a statistically significant difference for the HFS-30 and FaCE questionnaires. (4) Conclusions: This study showed that the BoNT injections lead to a significant increase in the QoL of patients with unilateral facial palsy. This improvement is sustained 4 months after the injections.

Cochlear implantation and facial nerve anastomosis to rehabilitate a burnt middle ear.

A 48-year-old man presented to the ENT department of a general hospital after a traumatic event that occurred at work. During arc welding, an incandescent metallic projectile entered the left external auditory canal immediately causing earache, tinnitus, hearing loss, vertigo, and completed peripheral facial palsy on the left side. A burnt middle ear is a rare situation for which very few cases are described in the literature. We describe and discuss our therapeutic strategy in an emergency setting. This can be of interest to any ENT surgeon who may face such a case of ear burn. Then we report the first repair of the facial nerve by interposition of an anastomosed intermediate graft associated with cochlear implantation during a single surgical intervention. This case illustrates the multimodal rehabilitation of the damage that can be a consequence of petrous trauma. The patient recovered hearing and facial motor skills.

Nasal and Pharyngeal Coil Extrusion After Embolization of an Internal Carotid Artery Pseudoaneurysm.

This case report describes a man in his 20s with a medical history of embolization of the right internal carotid artery who presented to the ears, nose, and throat emergency department with a wire in his mouth, throat discomfort, and irritating cough.

Pain in Patients with Post Paralytic Hemifacial Spasm: Before, during and after Botulinum Toxin Injections.

It is well-established that botulinum toxin (BT) injections improve quality of life in patients with postparalytic hemifacial spasm. Nevertheless, injection-related pain and contracture-related pain have not yet been studied. The primary objective of our study was to evaluate injection-related pain in patients with facial palsy sequelae, and to compare the standard technique (syringe) with the Juvapen device. The secondary objective was to evaluate the improvement of contracture-related pain one month after BT injection. METHODS: We conducted an observational, prospective, monocentric study based on 60 patients with facial palsy sequelae who received BT injections in our university ENT (ear, nose throat) department. There were 30 patients in the Juvapen group (J) and 30 in the standard technique group (ST). All patients completed Numerical Rating Scale (NRS) questionnaires immediately after the injections and one month later. RESULTS: The average NRS score was 1.33/10 with Juvapen and 2.24/10 with the standard technique (p = 0.0058; Z = 2.75). In patients with contracture-related pain, the average NRS score was 3.53 before BT injection, and 0.41 one month after BT injection (p = 0.0001). CONCLUSIONS: Juvapen is a less-painful injection technique than the standard one. BT reduces contracture-related pain one month after injection.

Oro-facial motor assessment: validation of the MBLF protocol in facial palsy.

BACKGROUND: Oro-facial myofunctional praxis assesses the muscular coordination and the degree of motor impairment of the lingual, mandibular and facial muscles necessary for articulation, mimicry and swallowing. PURPOSE: The objective of this study was to create and validate the MBLF protocol, a French oro-facial myofunctional assessment in order to quantify patient's impairment and to specify the motor and functional deficit for an adapted management. METHODS: The MBLF was validated against the Sunnybrook Facial Grading System (criterion validity). The construct validity was tested by comparing healthy subjects (n = 102) from patients with facial palsy (n = 60). Internal and external consistency of face symmetry were reported. Normative data was provided. RESULTS: There was a statistically significant correlation between the MBLF protocol and the Sunnybrook Facial Grading System [F(59) = 310.51, p < 0.001, R2 = 0.843]. Significant differences were observed in Student's t test between healthy volunteers and patients with facial palsy [t(74.13) = 14,704, p < 0.001, r = 0.863]. A significant effect of the severity grades of facial palsy on the MBLF_TOTAL scores was found [F(158) = 268.469, p < 0.001]. The more severe the facial palsy, the lower the motor scores were. CONCLUSION: This MBLF French validation provides a baseline for comparing and quantifying the performance of subjects. The MBLF protocol is valid for assessing facial symmetry in peripheral facial palsy. A prospective study is needed to validate its role in dynamic evaluation of facial palsy.