Verbesserung der Lebensqualität von Fazialisparese Patienten: FACE-Q® Evaluation der funktionellen Reanimation und Resymmetrisierung des gelähmten Gesichts von 66 Patienten.

Facial palsy – idiopathic, infectious or iatrogenic due to neurosurgical or ENT procedures – is the most frequent of cranial nerve lesion. Associated functional and aesthetic deficits impair the quality of life of patients. To determine treatment and outcome in our tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients treated between 2019 to 2023.

Observer-based analysis of facial function according to the House-Brackmann score (H&B) was compared to facial palsy-specific patient reported outcome measures (PROM) of the FACE-Q scale. Descriptive statistics for all measures were analyzed and correlations were calculated to compare facial palsy-specific instruments, as well as observer-based grading.

In total, 66 patients (80% female, median age 50 years) with acute and chronic facial palsy were included. A severe palsy (H&B °V-VI) was recorded in 51% while moderate palsy (H&B °III-IV) was treated in 29%. Etiology of palsy was iatrogenic (i.e., after vestibular schwannoma resection) in 68% of cases, further etiologies were neurofibromatosis, idiopathic palsy, cavernomas and meningeomas. Twenty-six peripheral nerve transfers were conducted and 25 cases combined with ancillary symmetrizing static procedures. Reconstructing the motor unit by functional muscle transfer was required in seven cases. Revisions of three cases were due to unfavorable lid chains. Patient satisfaction was highest in patients receiving invasive treatment for mild palsy (H&B ° I-II), followed by patients with severe impairment (H&B °V-VI). PROM of social function and satisfaction was lowest in the moderate palsy group despite improvements in smiling and eating distress functional scores.

Peripheral facial nerve surgery alongside adjacent symmetrizing procedures prove to be enhancing muscular, social and psychological function, highly influencing quality of life for patients with all severities of paralysis. To fully assess the burden of disease of facial palsy patients, validated disease-specific assessment should be applied in addition to standardized observer-based ratings. Patients treated for mild paralysis achieved highest satisfaction scores by supercharging end-to-side nerve transfer and aesthetic eyelid procedures. All functions need to be considered in reconstructing, reanimating and re-symmetrizing the paralyzed face.