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Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
Published on: March 1, 2015
Real-Time, Objective Assessment of Facial Paralysis Using a Mobile Tool (FaceADE): Feasibility Case-Control Study
Marcelina Puc1,2, Katherine Guo1,3, Anthony Newman1
1Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Medicine, Palo Alto, CA, United States.
Background:
Patients with facial paralysis require detailed clinical assessment and long-term follow-up to monitor facial function. The current standard of care for evaluating facial symmetry and movement uses validated clinician scoring tools such as the House-Brackmann facial paralysis score or the Electronic Clinician-Graded Facial Function Scale (eFACE). Existing tools are difficult to use in normal clinic workflows and do not provide real-time facial movement tracking, representing an unmet need. Therefore, we developed FaceADE, a novel iOS app leveraging native 3D image acquisition capabilities on the iPhone to rapidly quantify facial movement in patients with facial paralysis.
Objective:
This study aimed to benchmark FaceADE against 2D image analysis and establish the feasibility of measuring oral commissure movement in patients with facial paralysis and healthy controls.
Methods:
Patients were enrolled in a tertiary care clinic focused on facial paralysis treatment. Patients underwent image capture using the FaceADE app assisted by study team personnel. Measurements of lip commissure position and movement were obtained from 20 patients with facial paralysis and 10 healthy volunteers without facial paralysis. Measurements of lip movement and symmetry gathered from FaceADE were benchmarked against 2D measurements using open-source image analysis software (ImageJ).
Results:
FaceADE measurements of lip commissure position and movement showed strong agreement with 2D measurements in both healthy volunteer and facial paralysis cohorts. The intraclass correlation coefficient was 0.96 (95% CI 0.90-0.98; P<.001) in the healthy volunteer cohort and 0.82 (95% CI 0.72-0.88; P<.001) in the facial paralysis cohort. Bland-Altman analysis found strong agreement between the 2 methods for these measurements. The 95% CI contained 97.5% (39/40) of data points in the healthy cohort and 91.2% (73/80) of data points in the facial paralysis cohort.
Conclusions:
Our proposed mobile method of measuring clinically important lip commissure position and movement is feasible for use at the time of care delivery. In the future, this technology may be useful for a quantitative assessment of facial paralysis severity.
