Researchers studying facial reanimation surgeries lack a standard instrument for accurately comparing objective facial reanimation outcomes. As a result, surgeons who perform these procedures don’t have access to data that could help them better select techniques for patients, counsel patients, allocate resources and further innovation, according to a review published online in JAMA Facial Plastic Surgery.
Facial nerve deficits can negatively impact patients’ lives socially, psychosocially and functionally, according to the authors. While there are several surgical techniques addressing facial paralysis aspects, existing techniques aimed at dynamically restoring facial nerve function are imperfect, they write.
Historically, physicians have evaluated facial paresis outcomes using the House Brackmann grading scale, which the authors write was developed for recovery of intact facial nerves and lacks clear objective data that can be quantified and compared.
To determine what researchers are using to objectively measure outcomes in patients treated with dynamic methods for facial paralysis, the authors conducted a literature search from January 1970 to June 2017, yielding 49 studies — and analyzing a total 1,898 patients — that included an objective instrument for analysis post dynamic facial reanimation. All were retrospective and most were case series studies.
Researchers used 29 different instruments in those 49 studies, poorly describing the instruments in many cases. There were three objective instruments that were potentially reproducible and reported test validity, symmetry and multiple data points.
Overall, the lack of universal objective instruments hinders comparison of facial reanimation outcomes, the authors conclude.
“When treating facial paralysis, symmetry of movement is arguably more important than magnitude of movement in the measured area,” the authors write. “An ideal system would incorporate multiple areas of measurement to form a large data set that compares the intervention with the normal side. Preferably, this system would incorporate 3-dimensional analysis.”
The ideal facial nerve grading instrument would regionally score facial function, perform static and dynamic measures, examine secondary facial palsy sequelae, offer reproducible results, be sensitive to track changes over time and be convenient for clinicians to use, they write.