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Reliability Between In-Person and Still Photograph Assessment of Facial Function in Facial Paralysis Using the eFACE

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Photographic assessment using the electronic facial function scale (eFACE) shows high agreement with in-person evaluations for facial palsy patients. This method offers reliable, objective tracking of facial function and symmetry, improving remote patient monitoring.

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Area of Science:

  • Otolaryngology
  • Facial Plastic Surgery
  • Ophthalmology

Background:

  • Facial palsy assessment traditionally relies on in-person evaluations, limiting objective, long-term outcome tracking and remote monitoring.
  • Standardized photographic assessments can enhance data quality for artificial intelligence (AI)-driven grading and facilitate remote patient follow-up.

Purpose of the Study:

  • To evaluate the agreement between in-person and photographic assessments using the electronic facial function scale (eFACE).
  • To determine the inter-rater reliability of photographic eFACE evaluations for facial palsy patients.

Main Methods:

  • Retrospective review of eFACE scores from the Massachusetts Eye and Ear Standard Facial Palsy Dataset.
  • Two experienced facial reanimation surgeons independently assessed eFACE scores from both in-person interviews and standardized photographs.

Main Results:

  • High intraclass correlation coefficients (ICCs) were observed: 0.96 for total scores, 0.99 for static, 0.82 for dynamic, and 0.98 for synkinesis.
  • Mean differences between photographic and in-person scores were minimal (-0.64 total, -1.58 static, 0.14 dynamic, -1.11 synkinesis), with no significant trends identified by Bland-Altman analysis.

Conclusions:

  • Photographic eFACE assessment demonstrates excellent inter-rater reliability and strong agreement with in-person evaluations.
  • Standardized frontal photographs are a viable tool for monitoring facial symmetry and function in facial palsy patients, supporting remote care.