Function and Form Outcomes in Patients with Facial Paralysis

面瘫患者的功能和形态结果

• 批准号: 9112044
• 负责人: CARROLL ANN TROTMAN
• 金额: $ 25.96万
• 依托单位: TUFTS UNIVERSITY BOSTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-04 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9112044
• 关键词: Acute; Affect; Age; Antiviral Agents; Appearance; Area; Autoimmune Diseases; Behavior; Bell Palsy; Benign; Chronic; Clinical; Clinical assessments; Commissure; Contracture; Devices; Diagnosis; Dimensions; Disability Evaluation; Ear Diseases; Ectropion; Elements; Emergency department visit; Emotional; Esthetics; Evaluation; Eye; Face; Facial asymmetry; Facial nerve structure; Facial paralysis; Fees; Frequencies; Future; Future Generations; Goals; Health; Health Care Costs; Housing; Image; Impairment; Intervention; Joints; Left; Legal patent; Magnetic Resonance Imaging; Malignant Neoplasms; Matched Group; Measurement; Measures; Methods; Movement; Muscle; Nerve; Observational Study; Operative Surgical Procedures; Oral; Outcome; Paralysed; Participant; Patients; Perception; Peripheral; Pharmaceutical Preparations; Physical therapy; Process; Ptosis; Qualitative Methods; Quality of life; Recovery; Rehabilitation therapy; Research; Severities; Side; Smiling; Steroids; Surgeon; Syndrome; System; Testing; Time; Trauma; United States; United States National Institutes of Health; age group; base; cleft lip and palate; disability; novel; patient population; prospective; reconstruction; sex; social; soft tissue; treatment planning

 DESCRIPTION (provided by applicant): Patients with facial paralysis have an obvious facial disability including facial disfigurement and impairment in soft tissue movements, particularly in facial expressive behaviors. These negative physical sequelae not only impact facial esthetics and function, but also patients' social and emotional quality of life (QOL). Treatments range from non-surgical interventions and facial reanimation surgery to new implantable facial pacing devices that would potentially initiate artificial movement on the paralyzed side of the face. Traditionally, surgeons' plan treatment based on isolated measurements made from 2D photographs and subjective grading of the patient's face, both of which are limited in scope and dimension. Our research has demonstrated the utility of novel, landmark-based, 3D dynamic and static quantitative (objective) measures for the evaluation of facial soft tissue function (NIH DE 013814, DE 016964, and DE 013814-08S1). These measures have been validated for use in the cleft lip/palate (CL/P) patient population. The measures are objective and quantitative. They provide a more precise diagnosis of facial soft tissue disability and evaluation of surgical outcomes. The main goal of this prospective, observational study is to determine the applicability of these novel 3D dynamic and static measures for quantification and measurement of impairment and disfigurement, as well as change over time, in patients with facial paralysis. We will also explore the utility of non-landmark based dynamic and static measures. The global research question is whether the use of the measures will provide a more comprehensive analysis of the severity of facial paralysis and the changes over time (recovery) when compared with current assessment methods. The specific aims of the study are: Specific Aim 1. To quantitatively evaluate the range of facial soft tissue disability (facial impairment and disfigurement) in patients with acute, unilateral, flaccid facial paralysis and track the changes over time (3 month recovery period), and to compare the facial disability in the patients with a group of age- and sex-frequency matched normal subjects. Specific Aim 2. In patients with acute unilateral, flaccid facial paralysis, to compare the current qualitative clinical assessment methods for facial impairment and disfigurement (House-Brackman Facial Nerve Grading System & Sunnybrook Facial Grading System ) with the objective quantitative assessments in order to assess the differential information provided by a quantitative zonal analysis versus a qualitative global assessment. Specific Aim 3. (a) To assess perceptions of facial appearance and QOL over time in patients with acute, unilateral, flaccid facial paralysis and to compare these perceptions with those of control subjects, and (b) To correlate the patients' perceptions over time with the quantitative measures of facial disability. Ultimately, this study is unique for the rehabilitation of patients with facial paralysis in that the focus is on generating novel, objective, 3D measures to characterize the condition and temporal changes, and on the generation of future hypotheses to optimize interventions and assess the outcomes of the different treatments.

 描述（申请人提供）：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，特别是面部表情行为障碍。这些负面的身体后遗症不仅影响面部美观和功能，还影响患者的社会和情感生活质量（QOL）。治疗方法包括非手术干预和面部复活手术，以及新的植入式面部起搏装置，这些装置可能会在面部瘫痪的一侧引发人工运动。传统上，外科医生根据二维照片的单独测量和患者面部的主观分级来制定治疗计划，这两者的范围和尺寸都受到限制。我们的研究证明了新颖的、基于地标的、3D 动态和静态定量（客观）测量方法在评估面部软组织功能方面的实用性 (NIH) DE 013814、DE 016964 和 DE 013814-08S1)。这些措施已被验证可用于唇裂/腭裂 (CL/P) 患者群体。这些措施是客观的、定量的。它们可以更准确地诊断面部软组织残疾并评估手术结果。这项前瞻性观察性研究的主要目标是确定这些新颖的 3D 动态和静态测量对于面瘫患者损伤和毁容以及随时间变化的量化和测量的适用性。我们还将探索基于非地标的动态和静态措施的效用。全球研究的问题是，与目前的评估方法相比，这些措施的使用是否能够对面瘫的严重程度以及随时间的变化（恢复）提供更全面的分析。该研究的具体目的是： 具体目的 1. 定量评估急性单侧弛缓性面瘫患者的面部软组织残疾（面部损伤和毁容）范围，并跟踪随时间的变化（3个月恢复期），并将患者的面部残疾与一组年龄和性别频率匹配的正常受试者进行比较。具体目标 2. 在急性单侧弛缓性面瘫患者中，将当前面部损伤和毁容的定性临床评估方法（House-Brackman 面部神经分级系统和 Sunnybrook 面部分级系统）与客观定量评估进行比较，以评估定量分区分析与定性全局评估提供的差异信息。具体目标 3. (a) 评估急性、单侧、松弛性面瘫患者随时间推移对面部外观和生活质量的感知，并将这些感知与对照受试者的感知进行比较，以及 (b) 将患者随时间推移的感知与面部残疾的定量测量相关联。最终，这项研究的独特之处在于 面瘫患者的康复，重点是生成新颖、客观的 3D 测量来表征病情和时间变化，并生成未来假设以优化干预措施并评估不同治疗的结果。