title: Photographic Standards for Patients With Facial Palsy and Recommendations by Members of the Sir Charles Bell Society.
abstract: OBJECTIVE
  There is no widely accepted assessment tool or common language used by clinicians caring for patients with facial palsy, making exchange of information challenging. Standardized photography may represent such a language and is imperative for precise exchange of information and comparison of outcomes in this special patient population.
  
  
  OBJECTIVE
  To review the literature to evaluate the use of facial photography in the management of patients with facial palsy and to examine the use of photography in documenting facial nerve function among members of the Sir Charles Bell Society-a group of medical professionals dedicated to care of patients with facial palsy.
  
  
  METHODS
  A literature search was performed to review photographic standards in patients with facial palsy. In addition, a cross-sectional survey of members of the Sir Charles Bell Society was conducted to examine use of medical photography in documenting facial nerve function. The literature search and analysis was performed in August and September 2015, and the survey was conducted in August and September 2013.
  
  
  METHODS
  The literature review searched EMBASE, CINAHL, and MEDLINE databases from inception of each database through September 2015. Additional studies were identified by scanning references from relevant studies. Only English-language articles were eligible for inclusion. Articles that discussed patients with facial palsy and outlined photographic guidelines for this patient population were included in the study. The survey was disseminated to the Sir Charles Bell Society members in electronic form. It consisted of 10 questions related to facial grading scales, patient-reported outcome measures, other psychological assessment tools, and photographic and videographic recordings.
  
  
  RESULTS
  In total, 393 articles were identified in the literature search, 7 of which fit the inclusion criteria. Six of the 7 articles discussed or proposed views specific to patients with facial palsy. However, none of the articles specifically focused on photographic standards for the population with facial palsy. Eighty-three of 151 members (55%) of the Sir Charles Bell Society responded to the survey. All survey respondents used photographic documentation, but there was variability in which facial expressions were used. Eighty-two percent (68 of 83) used some form of videography. From these data, we propose a set of minimum photographic standards for patients with facial palsy, including the following 10 static views: at rest or repose, small closed-mouth smile, large smile showing teeth, elevation of eyebrows, closure of eyes gently, closure of eyes tightly, puckering of lips, showing bottom teeth, snarling or wrinkling of the nose, and nasal base view.
  
  
  CONCLUSIONS
  There is no consensus on photographic standardization to report outcomes for patients with facial palsy. Minimum photographic standards for facial paralysis publications are proposed. Videography of the dynamic movements of these views should also be recorded.
  
  
  METHODS
  NA.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Santosa
authors.affiliation: Facial Nerve Programme, Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children's National Health Service Foundation Trust, Liverpool, England.
authors.forename: Adel
authors.initials: A
authors.lastname: Fattah
authors.affiliation: Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gavilán
authors.affiliation: Facial Nerve Center, Division of Facial and Plastic and Reconstructive Surgery, Department of Otology and Laryngology, Harvard Medical School and Massachusetts Eye and Ear, Boston.
authors.forename: Tessa A
authors.initials: TA
authors.lastname: Hadlock
authors.affiliation: Facial Nerve Institute, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Snyder-Warwick
mesh_terms: D032921:Consensus; D003430:Cross-Sectional Studies; D004282:Documentation / Q000592:standards; D005149:Facial Expression; D005154:Facial Nerve / Q000503:physiopathology / Q000601:surgery; D005158:Facial Paralysis / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000592:standards*; D010781:Photography / Q000592:standards*; D012015:Reference Standards; D012955:Societies, Medical; D014741:Video Recording / Q000592:standards*