Publications

Abstract

BACKGROUND: Incidence data on Facial Nerve Disorders (FND) and Bell's palsy are currently limited. Prior epidemiological studies have estimated the incidence rate of Bell's palsy to be between 11 and 53/100,000 individuals, although the most cited incidence data are from single regions or municipalities, many of which are outdated from several decades ago.METHODS: This was a retrospective cohort study of US adults from 2007 to 2022 using the Merative Marketscan Research Databases. Trends in the incidence of FND were described overall and by specific sociodemographic groups, including age, sex, region, and insurance plan type. Chi-squared and simple logistic regression analyses were performed.RESULTS: From 2007 to 2022, the total adult incidence of all FND was 30.5/100,000, and the total incidence of Bell's palsy alone was 24.5/100,000. Over the study period, there was a significant annual increase of 2.1 cases of FND/100,000 adults (95% Confidence Interval [CI] 1.8, 2.3; p<0.001), and a significant total increase of 1.5 cases of Bell's palsy/100,000 adults (95% CI 1.2, 1.7; p<0.001). The total incidence of FND was higher in males (33.1/100,000) than in females (28.4/100,000, p<0.001), and greater in older age groups (p<0.001). Additionally, the incidence of FND varied significantly by region (p<0.001) and insurance plan type (p<0.001).CONCLUSIONS: This study provides up-to-date incidence rates for Bell's palsy and facial nerve disorders, based on national administrative claims data. Incidence rates of FND and Bell's palsy alone have been increasing in the United States from 2007 to 2022.LEVEL OF EVIDENCE: III Laryngoscope, 2025.

View details for DOI 10.1002/lary.31997

View details for PubMedID 39791289

Abstract

Artificial intelligence (AI), particularly computer vision and large language models, will impact facial plastic and reconstructive surgery (FPRS) by enhancing diagnostic accuracy, refining surgical planning, and improving post-operative evaluations. These advancements can address subjective limitations of aesthetic surgery by providing objective tools for patient evaluation. Despite these advancements, AI in FPRS has yet to be fully integrated in the clinic setting and faces numerous challenges including algorithmic bias, ethical considerations, and need for validation. This article discusses current and emerging AI technologies in FPRS for the clinic setting, providing a glimpse of its future potential.

View details for DOI 10.1016/j.otc.2024.05.002

View details for PubMedID 38971626

Abstract

Given the broad biological effects of the Hedgehog (Hh) pathway, there is potential clinical value in local application of Hh pathway modulators to restrict pathway activation of target tissues and avoid systemic pathway activation. One option to limit Hh pathway activation is using fibrin hydrogels to deliver pathway modulators directly to tissues of interest, bypassing systemic distribution of the drug. In this study, we loaded the potent Hh pathway agonist, SAG21k, into fibrin hydrogels. We describe the binding between fibrin and SAG21k and achieve sustained release of the drug in vitro. SAG21k-loaded fibrin hydrogels exhibit strong biological activity in vitro, using a pathway-specific reporter cell line. To test in vivo activity, we used a mouse model of facial nerve injury. Application of fibrin hydrogels is a common adjunct to surgical nerve repair, and the Hh pathway is known to play an important role in facial nerve injury and regeneration. Local application of the Hh pathway agonist SAG21k using a fibrin hydrogel applied to the site of facial nerve injury successfully activates the Hh pathway in treated nerve tissue. Importantly, this method appears to avoid systemic pathway activation when Hh-responsive organs are analyzed for transcriptional pathway activation. This method of local tissue Hh pathway agonist administration allows for effective pathway targeting surgically accessible tissues and may have translational value in situations where supranormal pathway activation is therapeutic.

View details for DOI 10.1016/j.ijbiomac.2024.131747

View details for PubMedID 38670196

Abstract

This article provides a brief historical overview of the assessment instruments that have been developed to categorize the severity of disease in patients with facial palsy. Important advances in the quality of these instruments in discussed. The modern day instruments that are commonly required for evidenced-based patient assessment are then presented, with emphasis on the level of evidence of the studies that describe these instruments.

View details for DOI 10.1055/a-2023-9051

View details for PubMedID 36720255

Abstract

Background: Facial palsy (FP) impacts verbal and nonverbal communication, but the effect of synkinesis on communicative ability is unknown. Objective: Among patients with nonflaccid FP, or synkinesis, is there a correlation between disease-specific quality-of-life and communicative ability or dysfunction? Methods: Retrospective study of a series of adult patients with unilateral synkinesis. Subjects were evaluated using the Communicative Participation Item Bank (CPIB) Short Form, Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Associations between these scales were evaluated by computing Pearson correlation coefficients. Results: A total of 69 confirmed synkinesis patients were included. Synkinesis patient mean (standard deviation) CPIB score was 20.68 (±8.27; range of scale 0-30), indicative of communication restriction. A strong correlation was observed between total CPIB and FaCE scores (r=0.66), indicating patients with synkinesis who reported better facial function also reported greater communicative ability. There was a weak correlation between CPIB and SAQ scores (r=-0.27). Conclusion: Synkinesis is associated with significant deficits in communicative ability. Communication restrictions track strongly with the FaCE scale.

View details for DOI 10.1089/fpsam.2022.0094

View details for PubMedID 36260346

Abstract

There is a paucity of research devoted to understanding the communication restrictions encountered by facial paralysis patients. We aim to explore the relationship between patient-reported restrictions in communicative participation and objective facial paralysis severity using validated scales of facial movement.We performed a pilot retrospective study using a consecutive series of adult patients with a diagnosis of unilateral facial paralysis. In addition to baseline demographics, subjects were evaluated using the Communicative Item Participation Bank Short Form (CPIB), Electronic Facial Assessment by Computer Evaluation (eFACE), and Sunnybrook Facial Grading System (SFGS).Twenty patients were included, 10 (50%) of whom were female with a mean age of 61 ± 13 years and mean duration of facial paralysis of 53 ± 82 months. The mean CPIB score was 14.6 ± 10.0 (range 0-29) and was comparable to scores of patients with conditions known to cause significant communicative disability. The mean eFACE scores were 67.4 ± 29.2, 44.2 ± 30.1, and 73.8 ± 30.0 for the static, dynamic, and synkinesis domains, respectively, with a composite smile score of 58.5 ± 16.9. After adjusting for age, gender, and duration of facial paralysis, significant moderate correlations were observed between the CPIB and the static eFACE domain (r = -0.51, P = .03) and smile composite score (r = 0.48, P = 0.0049), in addition to between the CPIB and SFGS synkinesis domain (r = 0.48, P = 0.04).Patients with unilateral facial paralysis experience significant limitations in communicative participation. These restrictions demonstrate moderate to strong correlations with objective assessments of facial paralysis and quality of life measures. Communicative participation may be a helpful means of tracking response to treatment.IV.

View details for DOI 10.1177/0003489420912446

View details for PubMedID 32192355

View details for DOI 10.1001/jamafacial.2019.0001

View details for Web of Science ID 000468394200013

Abstract

Importance: Problems with speech in patients with facial paralysis are frequently noted by both clinicians and the patients themselves, but limited research exists describing how facial paralysis affects verbal communication.Objective: To assess the influence of facial paralysis on communicative participation.Design, Setting, and Participants: A nationwide online survey of 160 adults with unilateral facial paralysis was conducted from March 1 to June 1, 2017. To assess communicative participation, respondents completed the Communicative Participation Item Bank (CPIB) Short Form questionnaire and the Facial Clinimetric Evaluation (FaCE) Scale.Main Outcomes and Measures: The CPIB Short Form and the correlation between the CPIB Short Form and FaCE Scale. In the CPIB, the level of interference in communication is rated on a 4-point Likert scale (where not at all=3, a little=2, quite a bit=1, and very much=0). Total scores for the 10 items range from 0 (worst) to 30 (best). The FaCE Scale is a 15-item instrument that produces an overall score ranging from 0 (worst) to 100 (best), with higher scores representing better function and higher quality of life.Results: Of the 160 respondents, 145 (90.6%) were women and 15 were men (mean [SD] age, 45.1 [12.6] years). Most respondents reported having facial paralysis for more than 3 years. Causes of facial paralysis included Bell palsy (86 [53.8%]), tumor (41 [25.6%]), and other causes (33 [20.6%]), including infection, trauma, congenital defects, and surgical complications. The mean (SD) score on the CPIB Short Form was 0.16 (0.88) logits (range, -2.58 to 2.10 logits). The mean (SD) score of the FaCE Scale was 40.92 (16.05) (range, 0-83.3). Significant correlations were observed between the CPIB Short Form and overall FaCE Scale scores, as well as the Social Function, Oral Function, Facial Comfort, and Eye Comfort subdomains of the FaCE Scale, but not with the Facial Movement subdomain.Conclusions and Relevance: Patients with facial paralysis in this study sample reported restrictions in communicative participation that were comparable with restrictions experienced by patients with other known communicative disorders, such as laryngectomy and head and neck cancer. We believe that communicative participation represents a unique domain of dysfunction and can help quantify the outcome of facial paralysis and provide an additional frame of reference when assessing treatment outcomes.

View details for PubMedID 29955841