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Worldwide Testing of the eFACE Facial Nerve Clinician-Graded Scale

Banks, Caroline A. M.D.; Jowett, Nathan M.D.; Azizzadeh, Babak M.D.; Beurskens, Carien P.T., Ph.D.; Bhama, Prabhat M.D.; Borschel, Gregory M.D.; Coombs, Christopher M.D.; Coulson, Susan M.D.; Croxon, Glen M.D.; Diels, Jaqueline O.T.; Fattah, Adel M.D.; Frey, Manfred M.D.; Gavilan, Javier M.D.; Henstrom, Douglas M.D.; Hohman, Marc M.D.; Kim, Jennifer M.D.; Marres, Henri M.D.; Redett, Richard M.D.; Snyder-Warwick, Alison M.D.; Hadlock, Tessa M.D.

Plastic and Reconstructive Surgery: February 2017 - Volume 139 - Issue 2 - p 491e–498e
doi: 10.1097/PRS.0000000000002954
Reconstructive: Head and Neck: Original Articles
Discussion

Background: The electronic, clinician-graded facial function scale (eFACE) is a potentially useful tool for assessing facial function. Beneficial features include its digital nature, use of visual analogue scales, and provision of graphic outputs and scores. The authors introduced the instrument to experienced facial nerve clinicians for feedback, and examined the effect of viewing a video tutorial on score agreement.

Methods: Videos of 30 patients with facial palsy were embedded in an Apple eFACE application. Facial nerve clinicians were invited to perform eFACE video rating and tutorial observation. Participants downloaded the application, viewed the clips, and applied the scoring. They then viewed the tutorial and rescored the clips. Analysis of mean, standard deviation, and confidence interval were performed. Values were compared before and after tutorial viewing, and against scores obtained by an experienced eFACE user.

Results: eFACE feedback was positive; participants reported eagerness to apply the instrument in clinical practice. Standard deviation decreased significantly in only two of the 16 categories after tutorial viewing. Subscores for static, dynamic, and synkinesis all demonstrated stable standard deviations, suggesting that the instrument is intuitive. Participants achieved posttutorial scores closer to the experienced eFACE user in 14 of 16 scores, although only a single score, nasolabial fold orientation with smiling, achieved statistically significant improvement.

Conclusions: The eFACE may be a suitable, cross-platform, digital instrument for facial function assessment, and was well received by facial nerve experts. Tutorial viewing does not appear to be necessary to achieve agreement, although it does mildly improve agreement between occasional and frequent eFACE users.

Boston, Mass.; Los Angeles, Calif.; Nijmegen, The Netherlands; Anchorage, Alaska; Toronto, Ontario, Canada; Melbourne, Victoria, and Sydney, New South Wales, Australia; Madison, Wis.; Liverpool, United Kingdom; Vienna, Austria; Madrid, Spain; Iowa City, Iowa; Tacoma, Wash.; Ann Arbor, Mich.; Baltimore, Md.; and St. Louis, Mo.

From the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, Harvard Medical School/Massachusetts Eye and Ear Infirmary; David Geffen School of Medicine at UCLA; the Department of Orthopedics/Physical Therapy and the Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center; the Department of Otolaryngology–Head and Neck Surgery Alaska Native Medical Center, Alaska Native Tribal Health Consortium; the Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children; the Department of Plastic and Maxillofacial Surgery, Royal Children’s Hospital; The University of Sydney and Royal Prince Alfred Hospital; the Department of Otolaryngology, Royal Prince Alfred Hospital; the Department of Orthopedics and Rehabilitation, University of Wisconsin Hospital and Clinics; the Facial Nerve Programme, Regional Paediatric Burns and Plastic Surgery; the Division of Plastic and Reconstructive Surgery, Medical University of Vienna; the Department of Otolaryngology Head and Neck Surgery, La Paz University Hospital, Idipaz Research Institute; the Division of Plastic Surgery and Cosmetic Services, Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics; Madigan Army Medical Center; the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Michigan; the Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; and the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis.

Received for publication December 6, 2015; accepted June 13, 2016.

Disclosure: The authors have no financial interest in any of the products or devices mentioned in this article.

Caroline A. Banks, M.D., Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, Harvard Medical School/Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Mass. 02114, caroline_banks@meei.harvard.edu

©2017American Society of Plastic Surgeons