Sydney Facial Nerve Clinic: experience of a multidisciplinary team

Abstract

Background: The Sydney Facial Nerve Clinic (SFNC) is a multidisciplinary clinic established in 2015, consisting of surgeons (otolaryngologists, head and neck and plastics/ reconstructive), physiotherapists and speech pathologists. Methods: We reviewed patients who attended the SFNC in the first 3 years and who had their symptoms recorded using the Facial Disability Index, and clinical staging recorded utilising the House-Brackmann (HB) score, Sydney Facial Nerve Score and Sunnybrook Facial Grading System (SFGS). Results: Between May 2015 and June 2018, 145 patients attended the clinic. Mean age was 44.6 AE 17.3 years with 94 (64.8%) females. Most referrals came from general practitioners (n = 75, 54.5%). The most common aetiology was iatrogenic injury (n = 55, 37.9%), followed by Bell's palsy (n = 48, 33.1%), congenital (n = 11, 7.6%), herpes zoster oticus (n = 9, 6.2%), trauma (n = 9, 6.2%) and other (n = 13, 9.0%). The median HB was 4, the mean Sydney score 7.3/15 and the mean SFGS was 45/100. Patients with iatrogenic causes had the worse facial nerve scoring in HB, Sydney and SFGS. Patients with congenital aetiology reported the least symptoms on Facial Disability Index (P < 0.001). Most patients were recommended non-surgical management (n = 92, 64.3%); 51 (35.7%) were referred for botulinum toxin + facial physiotherapy, 25 (17.2%) for physiotherapy alone, seven (4.9%) for botulinum toxin alone and nine (6.3%) for conservative management. Fifty-one patients (35.7%) were recommended surgery, generating 75 procedures; 24 oculoprotective, 22 static, 12 gracilis transfers, 10 temporalis myoplasties and seven nerve transfers. Conclusion: Iatrogenic injuries are the most common presentation for this clinic and have a more severe clinical presentation. Most patients presenting to the SFNC were managed non-surgically.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 856-860ANZJSurg.com

Facial nerve palsy: Narrative review on the importance of the eye and its assessment

“…Treatment was most commonly directed to eye problems (66% of the cases) with only 20% of the participants receiving surgical therapies. Even within the subset of patients who have surgery, procedures to eyelids are reported to be the most common 15,60,65,67 . A retrospective review of patients treated with periocular procedures at John Hopkins Hospital in 2015 showed that lid loading was by far the most commonly used surgical procedure (95 out of 101 cases) 19 .…”

“…64 In clinical practice a wide range of services are accessed by patients with FNP for the spectrum of problems they face. 15,65 Although most patients are managed non-operatively, it is not clear how much of this is simply due to lack of effective surgical solutions. 65 Szczepura et al carried out a national survey of 215 participants with FNP about their experience of treatment pathways.…”

“…15,65 Although most patients are managed non-operatively, it is not clear how much of this is simply due to lack of effective surgical solutions. 65 Szczepura et al carried out a national survey of 215 participants with FNP about their experience of treatment pathways. 66 Treatment was most commonly directed to eye problems (66% of the cases) with only 20% of the participants receiving surgical therapies.…”

“…Even within the subset of patients who have surgery, procedures to eyelids are reported to be the most common. 15,60,65,67 A retrospective review of patients treated with periocular procedures at John Hopkins Hospital in 2015 showed that lid loading was by far the most commonly used surgical procedure (95 out of 101 cases). 19 Ryzenman et al also found in their survey of 1595 patients with FNP that lid loading was the most common surgical intervention.…”

Evaluation of the Patient with Facial Palsy: A Multidisciplinary Approach

“…Prior to any intervention, it is important to consider which modality best suits the patient based on factors such as etiology, location of injury, patient age, life expectancy, psychological state, patient choice, existent comorbidities, sensory function of the trigeminal nerve, and oncological status. 37,57 In traumatic injury, availability of the proximal stump and extent of the facial nerve lesion are also important considerations. 58 Although differences in opinion do exist, in cases where the facial nerve remains anatomically intact, it is advisable allow a 12-month window prior to performing a procedure that will disrupt nerve integrity, to allow time for spontaneous recovery to occur.…”