Patients with facial paralysis have an obvious facial disability that includes facial disfigurement and
impairment in soft tissue movements, particularly in facial expressive behaviors. Management requires a
tailored and, at times, disparate approach to correct the facial disability ranging from non-surgical
interventions to facial reanimation surgery. Surgeons’ plan treatment based on measurements made from 2D
images and subjective grading of the patient’s face, both of which are limited in scope and dimension. Recently,
we demonstrated the utility of novel, landmark-based, 3D dynamic and static quantitative (objective) measures
and modeling comparisons for the evaluation of facial disability in patients with facial paralysis and tracked
their recovery over a 12-week period (NIH DE 025295). Thus, the overall goal of this prospective,
observational study is to compare the facial disability and perception outcomes of facial reanimation surgeries
in patients with extensive and permanent, unilateral paralysis using the refined 3D analysis, and compare
patient-centered outcomes of facial appearance, well-being, and satisfaction using validated questionnaires.
There will be three groups of surgery patients who will have a free gracilis muscle transfer. Group 1 will have
muscle transfer driven by the trigeminal nerve (nV); Group 2 will have muscle transfer driven by a cross-face
nerve graft (nVII); and Group 3 will have muscle transfer driven by dual innervation using both nerves. The
data from these groups will be compared with previously collected data from historical controls. The null
hypothesis to be tested is that there will be no difference in the impact of the surgical change on facial disability
(primary HO) or on patient perception (secondary HO) effected by the three different surgical approaches for
facial/smile reanimation after controlling for patient characteristics.
Specific Aim 1. To assess (1) the differences in facial disability (impairment and disfigurement) before surgery
among the three surgery groups and compared to a historical control group (control data collected during the
precursor R21 grant); (2) the changes in facial disability that occur at 5 and 18 months after surgery among the
three groups; and (3) the differences in persistent facial disability 18 months after surgery among the surgery
groups and compared to the control group. Outcomes: 3D measures of facial soft tissue displacement, velocity,
and disfigurement (form).
Specific Aim 2. To compare (1) the differences in self-perceptions of facial appearance/well-being and patient
satisfaction among the three surgery groups and control group before surgery; (2) the changes in self
perceptions from before to 18 months after surgery among the surgery groups; and (3) the differences in self
perceptions among the surgery groups and the control group at 18 months after surgery. Outcomes:
Qualitative measures using the Facial Clinimetric Evaluation Scale (FACE), Medical Outcomes Study Short
Form Scale (SF-36) and the Pre/Postsurgical Perception and Satisfaction Scale (PSP).
Specific Aim 3. To compare the objective, 3D, quantitative assessments of patients’ facial disability with
surgeons’ currently used subjective and 2D assessments for the same patients in order to assess the differential
information provided by the 3D assessment approach (such as area affected, severity of defect, and extent of
resolution of disability) that is not available from the current subjective and 2D assessments. Outcomes: 3D
measures of facial soft tissue displacement, velocity, and 3D disfigurement (form); and surgeons’ subjective
assessments from eFACE rating scale and 2D measures from Face-Gram/Emotrics software.