3D Dynamic and Patient-Centered Outcomes of Facial Reanimation Surgery in Patients with Facial Paralysis

面瘫患者有明显的面部残疾，包括面部毁容和 软组织运动障碍，尤其是面部表情行为障碍。管理需要一个 量身定做，有时是完全不同的方法，以纠正从非手术的面部残疾 面部复活手术的干预措施。基于2D测量的外科医生的计划治疗 患者面部的图像和主观分级，两者在范围和维度上都受到限制。最近， 我们展示了新的、基于里程碑的、3D动态和静态定量(客观)测量的实用性 面瘫患者和追踪患者面部残疾评估的模型比较 他们在12周内恢复(美国国立卫生研究院DE 025295)。因此，这个展望的总体目标是， 观察性研究是比较面部复活手术的面部残疾和知觉结果。 对广泛性和永久性的单侧瘫痪患者进行精细的3D分析，并进行比较 使用有效问卷，以患者为中心的面部外观、幸福感和满意度的结果。 将有三组手术患者免费进行股薄肌移植。组1将拥有 由三叉神经(NV)驱动的肌肉移位；组2将由十字面驱动的肌肉移位 神经移植物(Nvii)；组3采用双神经支配的肌肉移位。这个 来自这些组的数据将与之前从历史控制中收集的数据进行比较。空的 有待检验的假设是，手术改变对面部残疾的影响没有差别。 三种不同手术入路对患者感觉的影响(原发HO)或继发HO 在控制了患者的特征后，面部/微笑复苏。 具体目标1.评估(1)术前面部残疾(损伤和毁容)的差异 在三个手术组之间进行比较，并与历史控制组进行比较(在 先驱R21赠款)；(2)术后5个月和18个月发生在 三组；(3)术后18个月面部持续性残疾在不同手术组之间的差异 并与对照组进行比较。结果：面部软组织位移、速度、 和毁容(表格)。 具体目标2.比较(1)面容/幸福感自我知觉和患者自我知觉的差异 三个手术组与对照组的术前满意度比较：(2)自我的变化 手术组术前至术后18个月的认知；(3)自我差异 术后18个月手术组与对照组的认知情况。结果： 使用面部临床测量评估量表(FACE)的定性测量，医疗结果研究简报 形式量表(SF-36)和术前术后知觉与满意度量表(PSP)。 具体目标3.比较患者面部残疾的客观、3D、定量评估与 外科医生目前对相同患者使用的主观和2D评估，以评估差异 3D评估方法提供的信息(例如受影响的区域、缺陷的严重程度和 解决残疾问题)，这是目前的主观评估和2D评估所不具备的。结果：3D 测量面部软组织移位、速度和三维畸形(表格)；以及外科医生的主观感受 来自eFACE评级量表的评估和Face-Gram/Emotrics软件的2D测量。

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.