Translation and validation of the German version of the FACE-Q paralysis module in adult patients with unilateral peripheral facial palsy.

The aim was to develop and validate a German version of the FACE-Q paralysis module, a patient-reported outcome measure to assess health-related quality of life in adult patients with unilateral facial palsy. The FACE-Q craniofacial questionnaire, which includes the paralysis module, was translated. 213 patients with facial palsy completed the German FACE-Q paralysis along with the established FDI and FaCE questionnaires. Regression analyses were performed to examine the relationships between the different FACE-Q domains and patient and therapy characteristics. The FACE-Q scales had high internal consistency (Cronbach's alpha all > 0.6). High correlations were found between the FACE-Q and the FDI and FaCE (mean rho = 0.5), as well as within the FACE-Q (mean rho = 0.522). Unifactorial influences were found for all domains except Breathing (all p < 0.05). Multivariate independent predictors were found for some FACE-Q domains. Most influential predictors (> 8 subdomains): Patients who received physical therapy scored lower in ten subdomains than those who did not (all p < 0.05). Patients who had surgery scored lower in nine subdomains than patients without surgery (all p < 0.05). The German version of the FACE-Q Paralysis Module can now be used as a patient-reported outcome instrument in adult patients with facial nerve palsy.

Initial severity of motor and non-motor disabilities in patients with facial palsy: an assessment using patient-reported outcome measures.

Patients with facial palsy (FP) not only suffer from their facial movement disorder, but also from social and psychological disabilities. These can be assessed by patient-reported outcome measures (PROMs) like the quality-of-life Short-Form 36 Item Questionnaire (SF36) or FP-specific instruments like the Facial Clinimetric Evaluation Scale (FaCE) or the Facial Disability Index (FDI). Not much is known about factors influencing PROMs in patients with FP. We identified predictors for baseline SF36, FaCE, and FDI scoring in 256 patients with unilateral peripheral FP using univariate correlation and multivariate linear regression analyses. Mean age was 52 ± 18 years. 153 patients (60 %) were female. 90 patients (31 %) and 176 patients (69 %) were first seen <90 or >90 days after onset, respectively, i.e., with acute or chronic FP. House-Brackmann grading was 3.9 ± 1.4. FaCE subscores varied from 41 ± 28 to 71 ± 26, FDI scores from 65 ± 20 to 70 ± 22, and SF36 domains from 52 ± 20 to 80 ± 24. Older age, female gender, higher House-Brackmann grading, and initial assessment >90 days after onset were independent predictors for lower FaCE subscores and partly for lower FDI subscores (all p < 0.05). Older age and female gender were best predictors for lower results in SF36 domains. Comorbidity was associated with lower SF General health perception and lower SF36 Emotional role (all p < 0.05). Specific PROMs reveal that older and female patients and patients with chronic FP suffer particularly from motor and non-motor disabilities related to FP. Comorbidity unrelated to the FP could additionally impact the quality of life of patients with FP.

Nonmotor disabilities in patients with facial palsy measured by patient-reported outcome measures.

OBJECTIVES/HYPOTHESIS: To describe changes of motor and nonmotor disabilities in patient with peripheral facial palsy (FP) during treatment using the patient-reported outcome measures (PROMs) Facial Clinimetric Evaluation (FaCE), Facial Disability Index (FDI), and Short Form 36-Item Questionnaire (SF-36) and to analyze predictors for these changes STUDY DESIGN: Prospective, single-center longitudinal study. METHODS: One hundred twenty patients with FP underwent at least two PROMs between 2012 and 2015. Predictors for changes of the PROMs were analyzed univariately using Pearson's correlation and multivariately using linear regression models. RESULTS: The mean interval between onset of FP to first presentation was 29 ± 64 months and between first and final assessment 8.7 ± 7.2 months. Initial House-Brackmann grading was 4.0 ± 1.3 and final House-Brackmann grading was 2.8 ± 1.6 (P < .001). All mean FaCE and FDI but only some SF-36 subscores improved over time (all P < .05). Adjuvant treatment was an independent predictor for improvement of the FaCE Facial Comfort subscore (P = .015) and a malignant tumor as primary disease for improvement of the FaCE Oral Function subscore (P = .044). Unemployment was a predictor for improvement of the FDI Social/Well-Being Function (P = .035). First assessment <90 days after onset was a predictor for improvement of the SF-36 Bodily Pain subscore (P = .025), a primary malignant disease for improvement of the SF-36 General Health perception (P = .004), and idiopathic FP for improvement of the SF-36 Social Functioning subscore (P = .017). CONCLUSIONS: Changes of motor function revealed by classical grading systems mostly do not correlate with changes of nonmotor disabilities during treatment of FP. Many other factors are associated with changes of PROMs during the FP treatment. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1516-1523, 2016.

Comparison of in-plane and out-of-plane needle insertion with vs. without needle guidance.

PURPOSE: First comparison of two methods of needle insertion: long axis ("in-plane") versus short axis ("out-of-plane") approach, each with and without a prototype needle guidance system (NGS). MATERIALS AND METHODS: 24 medical students without prior experience punctured an ultrasound phantom (transparent except for the decklayer) in four conditions, with the goal of achieving as many accurate punctures as possible within a fixed time. RESULTS: Out-of-plane with NGS led to substantially more hits at first attempt than punctures without NGS (p < 0.001), as well as to a greater total number of hits (p = 0.004), and participants were faster to hit the target the first time (p = 0.009). CONCLUSIONS: Thus, navigation increases accuracy as well as efficiency of ultrasound guided punctures on the phantom. It could prove advantageous in clinical applications for fine needle biopsies, musculoskeletal injections, vascular access, and in regional anesthesia.