Quality of life and functional assessment of facial palsy patients: A questionnaire study.

BACKGROUND: Facial palsy leads to functional and aesthetic deficits, which impair the quality of life of affected patients. General health-related and disease-specific questionnaires are available for quality of life assessment. In this study, observer-based analysis of facial function (Sunnybrook Facial Grading Scale) was compared patient-based to facial palsy-specific gradings (Facial Clinimetric Evaluation Scale and Facial Disability Index), and general health-related quality of life questionnaires (SF-36). We hypothesized that only facial palsy-specific instruments capture functional and social impairments of affected patients. METHODS: Thirty facial palsy patients treated at a tertiary referral centre were included in this study. Inclusion criteria were unilateral facial palsy with stable facial function, age over 18 years and fluency in German. Facial function was assessed with general and disease-specific patient-reported outcome measures and subsequently evaluated by the treating facial plastic surgeon. Statistical analysis included descriptive statistics for all assessed measurements. Correlations were calculated to compare general and facial palsy-specific instruments, as well as observer-based grading. RESULTS: Observer-based evaluation of facial function correlated well to the patients-based assessment of physical function, however social subscores did not correlate demonstrating the limited correlation of patient distress and facial nerve impairment. Physical function scores of disease-specific instruments did not correlate with general health assessment scores, while social function scores showed moderate to good correlations. CONCLUSION: Validated disease-specific instruments are essential for the assessment of facial palsy patients. Patient-reported outcome measures like the FaCE Scale and the Facial Disability Index should be applied in addition to standardized observer-based ratings to capture the patients' perspective on functional and social impairments associated with facial palsy to fully assess the burden of disease.

[Aplasia cutis congenita]. / Aplasia cutis congenita.

BACKGROUND: Aplasia cutis congenita is a rare congenital disorder characterised by the absence of skin. It mostly affects the scalp, but may also involve deeper tissue layers such as bone or dura mater. Bleeding from the sagittal sinus and infections are the most common complications. Numerous case reports have been published, but there is no consensus on therapeutic management, which includes both conservative and surgical treatment. METHODS: We report on 3 newborns with aplasia cutis congenita solely affecting the skin without involvement of deeper tissue layers. All 3 patients were treated conservatively with fatty gauze being used as a wound dressing. The patients were monitored in tight intervals. RESULTS: In all 3 newborns, the skin defects healed within a few months without any complications. CONCLUSION: Conservative treatment with fatty gauze represents a reliable therapeutic option in case the disease solely affects the skin.

Ultrasound of the Hypoglossal Nerve in the Neck: Visualization and Initial Clinical Experience with Patients.

BACKGROUND AND PURPOSE: The hypoglossal nerve, providing motor innervation for the tongue, can be affected in many diseases of the neck and skull base, leading to dysarthria, dysphagia, and ultimately atrophy of the tongue. We determined the feasibility of direct visualization of the hypoglossal nerve in the neck with ultrasound, testing this technique on healthy volunteers and evaluating it in clinical practice. MATERIALS AND METHODS: The study consisted of 4 parts: first, ultrasound-guided perineural ink injections along the course of the hypoglossal nerve at 24 sides of 12 fresh, nonembalmed cadaver necks. Subsequently, the specimens were dissected to confirm the correct identification of the nerve. The second part was examination of healthy volunteers with ultrasound and measurement of cross-sectional areas for generating reference data. The third part was scanning of healthy volunteers by 2 resident physicians with little and intermediate experience in ultrasound. Fourth was examination with ultrasound of patients with motor symptoms of the tongue. RESULTS: The hypoglossal nerve was correctly identified bilaterally in all cadaveric specimens (24/24) and all volunteers (33/33). The cross-sectional area ranged from 1.9 to 2.1 mm(2). The resident physicians were able to locate the nerve in 19 of 22 cases, demonstrating that locating the nerve is reproducible and feasible even with intermediate experience in ultrasound. Finally, alterations of the hypoglossal nerve in disease states could be depicted. CONCLUSIONS: Direct, reliable, and reproducible visualization of the extracranial hypoglossal nerve with ultrasound is feasible.

[Proven and innovative operative techniques for reanimation of the paralyzed face]. / Bewährte und innovative operative Techniken zur Reanimation des gelähmten Gesichtes.

This overview on the currently most effective reconstructive techniques for reanimation of the unilaterally or bilaterally paralysed face includes all important techniques of neuromuscular reconstruction as well as of supplementary static procedures, which contribute significantly to the efficiency and quality of the functional overall result. Attention is paid to the best indications at the best time since onset of the facial palsy, depending on the age of the patient, the cause of the lesion, and the compliance of the patient for a long-lasting and complex rehabilitation programme. Immediate neuromuscular reconstruction of mimic function is favourable by nerve suture or nerve grafting of the facial nerve, or by using the contralateral healthy facial nerve via cross-face nerve grafting as long as the time since onset of the irreversible palsy is short enough that the paralysed mimic muscles can still be reinnervated. For the most frequent indication, the unilateral irreversible and complete palsy, a three-stage concept is described including cross-face nerve grafting, free functional gracilis muscle transplantation, and several supplementary procedures. In patients with limited life expectancy, transposition of the masseteric muscles is favoured. Bilateral facial palsy is treated by bilateral free gracilis muscle transplantation with the masseteric nerve branches for motor reinnervation. Functional upgrading in incomplete lesions is achieved by cross-face nerve grafting with distal end-to-side neurorrhaphy or by functional muscle transplantation with ipsilateral facial nerve supply.

Are there ethnic differences of facial movements between Europeans and Asians?

PURPOSE: Due to the widespread use of Free Functional Muscle Transplant (FFMT) around the world to reanimate the paralysed face, it is important to be aware of ethnic differences in facial movements. METHODS AND MATERIAL: Participants in this study were born in Taiwan (n=24) and Austria (n=24). Analyses were conducted applying the digitised three-dimensional video-analysis system. All 48 subjects have never undergone any treatments in the face nor did they have previous histories of craniofacial anomalies. RESULTS: In general, Europeans were observed to have larger facial movements than Asians, from 0.4 mm (e.g. 5.7%) up to 3.9 mm (e.g. 30.3%), on average 1.3 mm+/-0.82 SD (e.g. 20.6%). Particularly the eyebrow, nose and mouth regions show statistically significant larger excursions on average 1.4 mm (e.g. 19.9%), 1.3 mm (e.g. 34.6%) and 3.0 mm (e.g. 30.3%). One exception is in the eye region, where Asians have a larger excursion (1.4 mm, e.g. 15.8%) of the eyelids, due to the larger distances between the upper and lower eyelids in the rest position. CONCLUSION: Europeans have generally larger facial movements than Asians. Particularly the eyebrow, nose and mouth regions show statistically significant larger excursions; exception must be made to the eye region, where Asians have a larger excursion of the eyelids. This is the first step to gather essential information about the ethnical differences in facial movements, a factor that should be considered as FFMT is becoming more popular worldwide.

Three-dimensional video-analysis of facial movements in healthy volunteers.

The aim of this study was to determine the mean distances of facial movements in 24 healthy individuals aged between 22 and 70 years, using the digitised three-dimensional video-analysis system developed by Frey et al. The subjects were divided into three groups of eight. The first group consisted of individuals aged between 20 and 30 years (mean+/-s.d.=25.0+/-2.33 years). Subjects in the second group were aged between 40 and 50 years (mean+/-s.d.=46.8+/-2.53 years), and the third group consisted of subjects aged between 60 and 70 years (mean+/-s.d.=63.6+/-3.07 years). In all groups the sexes were equally represented. No subject had had treatment to the face, nor did they have paralysis, scars or diseases of the skin. Males showed larger movements of the face than females, on average by 1.40+/-0.73 mm (15.08%). Subjects aged between 60 and 70 years demonstrated the largest movements of the face. The evaluation of facial movements in 24 healthy volunteers showed that sex and age affect facial dynamics. Thus study generated three-dimensional standard values for healthy facial movements.