Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

Abstract

IMPORTANCE Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL).OBJECTIVE To measure the association between depression, QOL, and facial paralysis in patients seeking treatment at a facial plastic surgery clinic.DESIGN, SETTING, PARTICIPANTS Data were prospectively collected for patients with all-cause facial paralysis and control patients initially presenting to a facial plastic surgery clinic from 2013 to 2015. The control group included a heterogeneous patient population presenting to facial plastic surgery clinic for evaluation. Patients who had prior facial reanimation surgery or missing demographic and psychometric data were excluded from analysis.MAIN OUTCOMES AND MEASURES Demographics, facial paralysis etiology, facial paralysis severity (graded on the House-Brackmann scale), Beck depression inventory, and QOL scores in both groups were examined. Potential confounders, including self-reported attractiveness and mood, were collected and analyzed. Self-reported scores were measured using a 0 to 100 visual analog scale. RESULTSThere was a total of 263 patients (mean age, 48.8 years; 66.9% were female) were analyzed. There were 175 control patients and 88 patients with facial paralysis. Sex distributions were not significantly different between the facial paralysis and control groups. Patients with facial paralysis had significantly higher depression, lower self-reported attractiveness, lower mood, and lower QOL scores. Overall, 37 patients with facial paralysis (42.1%) screened positive for depression, with the greatest likelihood in patients with House-Brackmann grade 3 or greater (odds ratio, 10.8; 95% CI, 5.13-22.75) compared with 13 control patients (8.1%) (P < .001). In multivariate regression, facial paralysis and female sex were significantly associated with higher depression scores (constant, 2.08 [95% CI, 0.77-3.39]; facial paralysis effect, 5. 98 [95% CI,]; female effect, 1.95 [95% CI, 0.65-3.25]). Facial paralysis was associated with lower QOL scores (constant, 81.62 [95% CI,]; facial paralysis effect, −16.06 [95% CI,).CONCLUSIONS AND RELEVANCE For treatment-seeking patients, facial paralysis was significantly associated with increased depression and worse QOL scores. In addition, female sex was significantly associated with increased depression scores. Moreover, patients with a greater severity of facial paralysis were more likely to screen positive for depression. Clinicians initially evaluating patients should consider the psychological impact of facial paralysis to optimize care.LEVEL OF EVIDENCE 2.

Facial Palsy‐Specific Quality of Life in 920 Patients: Correlation With Clinician‐Graded Severity and Predicting Factors

“…There is relatively scant published information about FP disability as it relates to etiology. Most authors who studied it found that etiology was not a predicting factor of PROMs . One previous study compared the morbidity of facial nerve dysfunction arising from surgical intervention for VS (n = 53) with those resulting from Bell palsy (n = 22).…”

“…Most authors who studied it found that etiology was not a predicting factor of PROMs. 2,16,17 One previous study compared the morbidity of facial nerve dysfunction arising from surgical intervention for VS (n = 53) with those resulting from Bell palsy (n = 22). Investigators found that patients with facial nerve dysfunction arising from VS surgery experienced less morbidity than those with FP caused by Bell palsy.…”

“…It can be a devastating and disfiguring condition, leading to psychological difficulties and restrictions of facial expressions, and may have a dramatic impact on interpersonal relationships. 1 The impact of FP on quality of life (QoL) is well known, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] although sometimes no correlation has been found between severity of FP and QoL. [3][4][5][6]8,20 When it has been found, the correlation ranges from 0.13 to 0.66, 2,10,12,14,15,17,21,22 meaning that other factors may be important contributors to QoL in patients with FP.…”

“…However, the results are conflicting, and it is unclear which factors influence QoL in FP patients, and in what way. [2][3][4][6][7][8][9][11][12][13][14][16][17][18] Increasing knowledge about factors influencing QoL in FP is clinically relevant and will help the multidisciplinary team guide patient care.…”

Objectively measuring social attention of thyroid neck scars and transoral surgery using eye tracking

“…20,21,23,24 Further, these eye movement aberrations correlated with changes in observer perception in the domains of attractiveness, QOL, and affect. 23,[25][26][27][28][29] We can correlate these findings to thyroid neck scars, where understanding the basis for why observers perceive patients with thyroid neck scars differently on social metrics of attractiveness, QOL, and overall neck appearance requires a clearer understanding of where observers direct their attention when making these assessments.…”