title: Clinician-Graded Electronic Facial Paralysis Assessment: The eFACE.
abstract: BACKGROUND
  The subjective nature of facial aesthetics and the difficulties associated with quantifying facial function have made outcomes analysis in facial paralysis challenging. Clinicians rely on photographs, subjective descriptions, and scales, limiting assessment, communication among providers, and communication between providers and patients. The authors describe the development and validation of a comprehensive, electronic, clinician-graded facial function scale (eFACE), which generates an overall disfigurement score and offers simple graphic output for clinician communication, assessment of various interventions, and patient understanding. The eFACE application may be used in a variety of electronic devices, including smartphones, tablets, and computers.
  
  
  METHODS
  An instrument consisting of 16 items in a visual analogue scale format was developed to assess facial function and symmetry (the eFACE). Video recordings of subjects performing facial expressions were viewed, and the eFACE instrument was applied, along with an overall facial disfigurement score. A multiple regression analysis was performed to determine the best linear relationship between overall expert-determined disfigurement and the eFACE items. The resulting equation was tested by three independent facial nerve clinicians, using an additional series of patients, to determine both interrater and intrarater reliability of the instrument.
  
  
  RESULTS
  Multiple regression analysis produced good fit of eFACE parameters to overall expert-rated global facial disfigurement when dynamic parameters were weighted twice as heavily as static and synkinesis parameters. eFACE scores demonstrated very high interrater and intrarater reliability.
  
  
  CONCLUSIONS
  The eFACE is a reliable, reproducible, and straightforward digital clinical measure with which to assess facial function and disfigurement in patients with facial paralysis.
authors.affiliation: Boston and Waltham, Mass.; and Anchorage, Alaska From the Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology/Head and Neck Surgery, Harvard Medical School/Massachusetts Eye and Ear Infirmary, Harvard Medical School/Boston Children's Hospital, the Department of Mathematical Sciences, Bentley University; and the Department of Otolaryngology-Head and Neck Surgery, Alaska Native Medical Center, Alaska Native Tribal Health Consortium.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Banks
authors.forename: Prabhat K
authors.initials: PK
authors.lastname: Bhama
authors.forename: Jong
authors.initials: J
authors.lastname: Park
authors.forename: Charles R
authors.initials: CR
authors.lastname: Hadlock
authors.forename: Tessa A
authors.initials: TA
authors.lastname: Hadlock
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004954:Esthetics; D005145:Face / Q000503:physiopathology*; D005149:Facial Expression; D005152:Facial Muscles / Q000503:physiopathology; D005158:Facial Paralysis / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014741:Video Recording