Patient-Reported Outcomes after Chemodenervation for Facial Paralysis Are Largely Dependent on Treatment of Lower Lip Depressors
Alexandra Marie Keane, BA; Katherine Bernadette Santosa, MD, MS; Alison K. Snyder-Warwick, MD
Washington University School of Medicine, St. Louis, MO
Facial paralysis results in devastating functional, aesthetic, and psychological consequences. Recent studies have demonstrated that chemodenervation with botulinum toxin is a safe and effective adjunct to improve facial symmetry. Yet, there is a paucity of literature describing patients' experiences with chemodenervation. Patients with facial paralysis reported improved quality of life (QOL) after chemodenervation in a single previous study (Mehta and Hadlock, 2008). In the senior author's practice, chemodenervation of the lower lip depressors is performed for functional and aesthetic concerns. We investigated whether chemodenervation of the lower lip depressors contributes most significantly to improved patient-reported outcomes (PROs) in patients with facial paralysis.
A retrospective chart review was performed from July 1, 2015 to June 30, 2018 to identify patients with facial paralysis who underwent lower lip depressor chemodenervation for facial asymmetry. All patients were treated by a single plastic surgeon at our institution. Facial Clinimetric Evaluation (FaCE) Scale surveys were administered to patients prior to and after chemodenervation to assess PROs. Facial Movement, Facial Comfort, Oral Function, Eye Comfort, Lacrimal Control, and Social Function sub-scores, and Total Score (all out of 100 total points) were derived from the FaCE survey. Four additional patients are currently recruited for this study, but their data are incomplete.
Seven patients were included: 4 patients underwent chemodenervation of only the lower lip depressors (LLD), and 3 patients underwent chemodenervation of the lower lip depressors and other face locations (LLD+). When analyzed as a single cohort, PROs improved for all scores when comparing pre- and post-injection FaCE scores, however statistical significance was only achieved for Total Score (47 vs 69, p=0.02). When comparing the LLD to the LLD+ groups, PROs improved minimally, or even worsened, for scores in the LLD+ cohort when comparing pre- and post-injection FaCE scores. However, PROs showed marked improvement in all scores in the LLD cohort when comparing pre- and post-injection FaCE scores, with statistically significant improvement in Facial Movement (8.3 vs 50, p=0.03), Eye Comfort (44 vs 78, p=0.04), and Total Score (45 vs 82, p=0.008). Patient recruitment and data analysis are ongoing.
Based on our preliminary results, PROs improve after chemodenervation for facial asymmetry. In line with our hypothesis, our results suggest that alleviating lower lip asymmetry contributes most significantly to improving patients' QOL in the patient population studied.
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