Evaluation of Societal Health Utility of Facial Palsy and Facial Reanimation

Abstract

Importance: The severity of a health state may be quantified using health utility measures. The utility of flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome with synkinesis may be challenging to discern from photographs alone.

Objective: To determine the societal health utility of flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, and post-facial reanimation using standard video.

Design, setting, and participants: This survey study was conducted at the Massachusetts Eye and Ear and the Harvard Decision Science Laboratory from June 14, 2017, to August 3, 2017. Healthy adult naïve observers were recruited through advertising in the Cambridge, Massachusetts, area. Participants (n = 298) completed the web-based, interactive survey in person. The survey comprised clinical vignettes consisting of symptom summaries, videos, and pictures depicting 5 health states.

Main outcomes and measures: Adult naïve observers ranked the utility of 5 randomized health states (flaccid unilateral facial paralysis, unilateral moderate to severe postparalytic facial nerve syndrome, post-facial reanimation, monocular blindness, and binocular blindness) according to the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) measures. Standard videos of patients' facial function were used.

Results: In total, 377 naïve observers were recruited and completed the survey in its entirety. Of the 377 participants, 298 (79.0%) were included for analysis. Among the 298 participants, 151 (50.7%) were female, 146 (49.0%) were male, with a mean (SD) age of 33.0 (15.1) years. No differences in health utility scores (SD) were observed between flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome (VAS: 0.598 [0.213] vs 0.629 [0.207]; SG: 0.714 [0.245] vs 0.748 [0.237]; TTO: 0.716 [0.248] vs 0.741 [0.247]). Both health states rated substantially worse than monocular blindness (VAS: 0.691 [0.212]; SG: 0.817 [0.204]; TTO: 0.826 [0.196]) and post-facial reanimation (VAS: 0.742 [0.189]; SG: 0.833 [0.206]; TTO: 0.838 [0.19]).

Conclusions and relevance: Health utility scores for flaccid unilateral facial paralysis and unilateral moderate to severe postparalytic facial nerve syndrome appeared to be equivalent and worse than that for monocular blindness, whereas scores for post-facial reanimation were substantially higher than the scores for the 2 facial movement disorders. These findings may provide insights into the societal advantages of facial reanimation surgery.

Level of evidence: NA.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.. Graphical User Interface of Health Utility Survey

A, Frame grabs from video vignettes demonstrating flaccid unilateral facial paralysis (A), unilateral moderate to severe postparalytic facial nerve syndrome with marked synkinesis (B), and post–facial reanimation surgery by eyelid weighting for eye closure and free functional gracilis transfer for smile reanimation (C). A standard set of facial expressions may be viewed in their entirety in Video 1, Video 2, and Video 3. D, The visual analog scale, a standard gamble iteration, and a time trade-off iteration are demonstrated. Visual cues (yellow happy faces, red sad faces, and large X’s) were employed to facilitate survey participants’ understanding of risk percentages.