Botulinum Toxin and Quality of Life in Patients With Facial Paralysis

Mehta, Ritvik P.; Hadlock, Tessa A.

doi:10.1001/archfaci.10.2.84

Cited by 86 publications

(70 citation statements)

References 23 publications

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“…It has been used extensively in the literature to report QOL improvement after a variety of treatment modalities in patients with both flaccid paralysis and NFFP. 7,8,14,19 A recent systematic review of patient-reported outcome measures determined that the FaCE scale was 1 of only 3 questionnaires among the 28 questionnaires reviewed that satisfied the authors' inclusion and exclusion criteria. 9 The authors concluded that the FaCE scale extensively covered both physical and social functioning but was limited by the use of classical test theory, which assumes that all items contribute equally to the final score.…”

Section: Discussionmentioning

confidence: 99%

“…The Facial Clinimetric Evaluation (FaCE) scale is a validated patient-based instrument designed to measure facial impairment and disability, and it permits clinicians to effectively analyze disease-specific quality of life (QOL). 6 The instrument has been used in previous research to show the adverse consequences of synkinesis 7 and the benefits of periocular surgery on QOL. 8 A recent systematic review of patient-reported outcome measures for facial paralysis reported that the FaCE scale is 1 of only 3 questionnaires that satisfied the authors' inclusion criteria.…”

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confidence: 99%

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Quality-of-Life Improvement After Free Gracilis Muscle Transfer for Smile Restoration in Patients With Facial Paralysis

Lindsay

Bhama

Hadlock

2014

JAMA Facial Plast Surg

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IMPORTANCE Facial paralysis can contribute to disfigurement, psychological difficulties, and an inability to convey emotion via facial expression. In patients unable to perform a meaningful smile, free gracilis muscle transfer (FGMT) can often restore smile function. However, little is known about the impact on disease-specific quality of life.OBJECTIVE To determine quantitatively whether FGMT improves quality of life in patients with facial paralysis. DESIGN, SETTING, AND PARTICIPANTS Prospective evaluation of 154 FGMTs performed at a facial nerve center on 148 patients with facial paralysis. The Facial Clinimetric Evaluation (FaCE) survey and Facial Assessment by Computer Evaluation software (FACE-gram) were used to quantify quality-of-life improvement, oral commissure excursion, and symmetry with smile. INTERVENTION Free gracilis muscle transfer. MAIN OUTCOMES AND MEASURES Change in FaCE score, oral commissure excursion, and symmetry with smile. RESULTS There were 127 successful FGMTs on 124 patients and 14 failed procedures on 13 patients. Mean (SD) FaCE score increased significantly after successful FGMT (42.30 [15.9] vs 58.5 [17.60]; paired 2-tailed t test, P < .001). Mean (SD) FACE scores improved significantly in all subgroups (nonflaccid cohort, 37.8 [19.9] vs 52.9 [19.3]; P = .02; flaccid cohort, 43.1 [15.1] vs 59.6 [17.2]; P < .001; trigeminal innervation cohort, 38.9 [14.6] vs 55.2 [18.2]; P < .001; cross-face nerve graft cohort, 47.3 [16.6] vs 61.7 [16.9]; P < .001) except the failure cohort (36.5 [20.8] vs 33.5 [17.9]; Wilcoxon signed-rank test, P = .15). Analysis of 40 patients' photographs revealed a mean (SD) preoperative and postoperative excursion on the affected side of −0.88 (3.79) and 7.68 (3.38), respectively (P < .001); symmetry with smile improved from a mean (SD) of 13.8 (7.46) to 4.88 (3.47) (P < .001). CONCLUSIONS AND RELEVANCEFree gracilis muscle transfer has become a mainstay in the management armamentarium for patients with severe reduction in oral commissure movement after facial nerve insult and recovery. We found a quantitative improvement in quality of life after FGMT in patients who could not recover a meaningful smile after facial nerve insult. Quality-of-life improvement was not statistically different between donor nerve groups or facial paralysis types.LEVEL OF EVIDENCE 3.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Quality-of-Life Improvement After Free Gracilis Muscle Transfer for Smile Restoration in Patients With Facial Paralysis

Lindsay

Bhama

Hadlock

2014

JAMA Facial Plast Surg

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“…These results quantify the physical effect of Botulinum toxin, which other authors have previously shown to result in an improvement in patients' quality of life. 5 This quantification will be useful if comparisons of the efficacy of different Botulinum toxin preparations were to be made. However, a limitation of this method is that it is specific for quantifying oral-ocular synkinesis and cannot in its present form be used to quantify other types of facial synkinesis.…”

Section: Discussionmentioning

confidence: 99%

“…Synkinesis, therefore, frequently has a negative effect on a patient's quality of life. 4,5 Since the early 1990s, directed Botulinum toxin injection to affected muscles has been the mainstay of treatment of synkinetic movement disorders. 6,7 The Botulinum toxin inhibits the release of acetylcholine from the presynaptic nerve terminal at the neuromuscular junction, preventing the propagation of the action potential and contraction of the targeted muscle.…”

Section: Introductionmentioning

confidence: 99%

“…The resulting (temporary) paralysis of synkinetic muscles has been demonstrated to improve the quality of life in affected individuals. 5 However, the optimal dosing range of Botulinum toxin for treating synkinesis has not yet been established. It is frequently administered on an ad hoc basis, exposing patients to the possibility of under-or overtreatment.…”

Section: Introductionmentioning

confidence: 99%

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Validation of a new photogrammetric technique to monitor the treatment effect of Botulinum toxin in synkinesis

Mabvuure

Hallam

Venables

et al. 2013

Eye

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Aims To validate a new photogrammetric technique for quantifying eye surface area and using this to quantify the degree of improvement in symmetry in patients with oral-ocular synkinesis following Botulinum toxin injection. Study design Feasibility study and retrospective outcomes analysis Methods Ten patients' photographs were chosen from a photographic database. Their eye surface areas were measured independently by two raters using a graphics tablet. One rater repeated the procedure after 15 days. Bland-Altman plots were computed, ascertaining inter-rater and intra-rater variability. The eye surface areas of 19 patients were then derived from photographs taken before and after Botulinum toxin injections. Paired t-tests were used to analyse the significance of the difference in pre-and post-treatment symmetry. Results Ninety per cent of eye surface areas derived from the two raters were within a coefficient of variation of 0.1 (95% CI: 0.05-0.15). Similarly, 90% of eye surface areas derived from one rater had a coefficient of variation of 0.08 (95% CI: 0.04-0.12). Botulinum toxin significantly reduced synkinesis resulting from lip puckering, Mona Lisa smiling and Hollywood smiling (Po0.05).Conclusions We have proposed a clinically valid tool for quantifying the effects of Botulinum toxin treatment for oral-ocular synkinesis. We recommend this method be used to monitor the response of such patients when receiving Botulinum toxin treatment.Level of evidence 2c.

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Surgical Treatment of the Periocular Complex and Improvement of Quality of Life in Patients With Facial Paralysis

Henstrom

Lindsay

Cheney

et al. 2011

Archives of Facial Plastic Surgery

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Botulinum Toxin and Quality of Life in Patients With Facial Paralysis

Cited by 86 publications

References 23 publications

Quality-of-Life Improvement After Free Gracilis Muscle Transfer for Smile Restoration in Patients With Facial Paralysis

Quality-of-Life Improvement After Free Gracilis Muscle Transfer for Smile Restoration in Patients With Facial Paralysis

Validation of a new photogrammetric technique to monitor the treatment effect of Botulinum toxin in synkinesis

Surgical Treatment of the Periocular Complex and Improvement of Quality of Life in Patients With Facial Paralysis

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