Abstract Otology 2000 B17-1

Pavel Dulguerov MD, Desheng Wang MD, Thomas V. Perneger MD, Willy Lehmann MD

Division of Head & Neck Surgery Geneva University Hospital CH-Geneva

Objective: In the process of developing a simple and objective measure of facial neuromuscular function, to: 1) determine the best measures for five basic facial movements in normal patients, 2) correlate these measurements with the House-Brackmann grades (HB) in patients with various degrees of facial paralysis. Methods: Eleven facial landmarks were placed on the face and five movements (forehead lift, eye closure, nose wrinkling, lip puckering, and smiling) with maximal contraction force were requested. No specific immobilization of the head was done. The videoframes with maximal movement digitized and measurements performed with the Osiris public domain image analysis software (www.expasy.ch). For each measure the change from rest was computed. Inter- and intrasubject variability were determined through a multivariate ANOVA analysis and correlation with HB was assessed with the Pearson correlation coefficient. Results: In all movements, surfaces changes were higher than distance changes. For forehead lifting and eye closure the best measure was the "eye surface" changes (area F-Na-Io) with 12 ( 9 % and -31 ( 8 % respectively. For nasal wrinkling, lip puckering, and smiling the best measures were the paranasal area (area Na-Io-A, change: -28 ( 14 %), upper lip area (area A-Ls-M, change -23 ( 8 %), and mouth area (area Ls-Li-M, change 63 ( 21 %), respectively. Distance changes were all below 10%. Same day repeatability was below 15% and day-to-day repeatability was below 7%. In normal subjects >80% of the total variation was accounted for by the intersubject variability. An excellent correlation with HB was found ((:0.5-0.8; p<0.001). Conclusion: Videomimicography is a simple and objective linear measurement system based on facial surface changes. The measures exhibit good reliability and an excellent correlation with HB grades.

Abstract Otology 2000 B17-2

Sandro Stöckli MD (1), Henning Scriba Ph.D. (2), Claudia Dornier MD (1), Anita Pollak MD (1), Thomas Linder MD (1), Ugo Fisch MD (1)

(1) ENT Department University Hospital CH-Zürich
(2) Department of Maxillofacial Surgery University of Zurich CH-Zürich

The aim of this study was to determine the normative data in healthy subjects as well as in patients with unilateral complete facial palsy using the computer-assisted system for objective scaling of facial nerve function based on area analysis (OSCAR). The luminance in the three facial areas forehead, eye and mouth was measured digitally during wrinkling of the forehead, forced eye closure, maximal smiling and subtracted from the image at rest. The percentage of change in luminance of the "weaker" versus the "better" facial side correlates with the degree of motion and gives a Regional Symmetry Index (RSI) for each facial area separately. For clinical evaluation a Global Symmetry Index (GSI) representing the facial symmetry in one number was determined. In 20 healthy subjects the mean RSI for the three regions of interest were: forehead 91% (SD 6%; range 80-99%); eyes 93% (SD 5%; range 82-100%) and mouth 91% (SD 5%; range 79-98%), respectively. The mean GSI was 92% (SD 3%; range 88-96%). The mean RSI of 19 paralytic faces were: forehead 6% (SD 6%; range 0-22%); eyes 33% (SD 10%; range 19-56%) and mouth 4% (SD 4%; range 0-14%), respectively. The mean GSI was 16% (SD 4%: range 9-25%). These results suggest that normal facial motor function includes a mean physiologic asymmetry of 7 to 9%. In the clinically paralytic faces motion was measured during eye closure, which is attributed to passive lid closure after relaxation of the levator muscle. By excluding this motion from the analysis the GSI drops to 3.4% (SD 4%; range 0.1-13%). Using the computerized OSCAR-method we were able to measure even small physiologic asymmetries and to determine normative values for complete paralysis.

Abstract Otology 2000 B17-3

Christopher Linstrom MD, Carol A. Silverman PhD, William M. Susman PhD, Clodualdo Orquiza III MD, Douglas Colson B.S., Tina M. Presutti B.S.

Otolaryngology New York Eye and Ear Infirmary USA-New York, NY

Outcome studies on the diverse medical and surgical treatments for facial paresis and paralysis are notably lacking. The primary obstacle has been the absence of objective, reliable, and sensitive measures of the spatial and temporal aspects of facial motion at specified facial landmarks. The purpose of this study was to objectively assess facial motion, using a commercially available motion analysis system, in persons with facial dysfunction. Subjects comprised five patients with various facial disorders and two normal adults. Two of the five subjects with facial dysfunction were evaluated following facial-nerve decompression, facial-nerve reconstruction, and/or facial re-animation. Facial motion at various facial marker locations at rest and during facial expressions was assessed with a motion analysis system, which uses video and computer motion-measurement technology. The motion-analysis software automatically computed the marker motion over time. Time plots, based on the average of five repetitions of each expression, were obtained for marker displacements, velocities, and accelerations. The time plots identified and quantified one or more of the following in all of the pathologic subjects: (a) lagophthalmos and incomplete eye closure despite the subjective impression of eye closure; (b) asymmetry at rest; (c) asymmetry during facial motion but not at rest; (d) synkinesis. Lagophthalmos was revealed through the asymmetric slopes of the displacement, velocity, and acceleration time plots during the contraction phase of eye closure. These results suggest the potential feasibility of this objective approach to evaluate the efficacy of facial reconstruction and re-animation and to quantify the natural history of various facial disorders.

Abstract Otology 2000 B17-4

Kiyotaka Murata MD, Michio Isono MD, Kei Saito MD, Hiroaki Miyashita MD

ENT Department Kinki University School of Medicine J-Osaka

An objective and quantitative evaluation system must be developed to estimate synkinesis following facial nerve palsy. We developed our system using computer analysis and rating scores. The computer system included a video and infrared cameras. Markers were placed on the face. Their movements were recorded in a computer. After image processing, movements of the markers were quantitatively expressed for analysis. Using an infrared camera, the velocity of each point could be evaluated. The triangle areas made by 3 markers were measured. In a normal face, involuntary movement of the supralabial area was detected during eye closure. This area at that time became significantly smaller, while it became larger when making wrinkles on the forehead. The trajectory length of a marker was calculated . The trajectory of a supralabial marker was significantly longer in postparalytic synkinesis than in normal physiological motions. Relationship between movement of the supralabial marker during contraction of eyes and that of the palpebra marker was analyzed in mild and severe abnormal synkinetic motions. Velocity, synchronization of the movement and strength of motion between them were analyzed. The severity of synkinesis was rated using a 3-point scale ranging from 0 to 2. Velocity of the supralabial marker increasesd with an increased score. Multivariate analysis revealed that the palsy scores 2 weeks and 2 months after palsy onset were the most important predictive factors of the synkinesis.

Abstract Otology 2000 B17-5

Henning Scriba Ph.D. (1), Verena Meier-Gallati MD (2), Anita Pollak MD (2)

(1) Department of Maxillofacial Surgery University of Zurich CH-Zürich
(2) ENT Department University Hospital CH-Zürich

Using the OSCAR method (Objective scaling of facial nerve function based on area analysis) a new percentile scaling system is presented which allows to measure facial synkinesis in an objective and quantitative way. In a pilot study the movement in the mouth region of 10 patients showing partial facial palsy with synkinesis has been analyzed. By comparing synkinesis with the possible active movement a percent scale can be defined. As it is difficult to distinguish between involuntary and voluntary components, the maximal and the probable degree of synkinesis have been measured, showing values of up to 103% and 84%, respectively.