Effect of Underlying Mental Health Disorders on the Correlation Between Patient- and Surgeon-Graded Synkinesis Scores
Publication: Facial Plastic Surgery & Aesthetic Medicine
Abstract
Background: Little is known about how depression and appearance anxiety affect patient reporting of synkinesis severity.
Learning/Study Objective: Measure prevalence of depression and appearance anxiety in facial synkinesis and correlations between subjective and surgeon-graded synkinesis severity.
Design Type: Prospective cohort.
Methods: Patients with synkinesis volunteered and completed: Synkinesis Assessment Questionnaire (SAQ), facial clinimetric evaluation (FaCE) scale, Center for Epidemiological Studies Depression Scale (CES-D), and Fear of Negative Appearance Evaluation Scale (FNAES). Standardized videos were scored by facial plastic surgeons using Sunnybrook Scale and eFaCE. Multivariate linear regression was used to compare patient- and surgeon-graded metrics.
Results: One hundred patients participated, 91 were female. Mean age was 56.4 (12.3). Eight percent identified as Black and 87% White. The most common nerve injury etiology was idiopathic (47%). Mean synkinesis duration was 7.6 years (6.2). Twenty percent and 15% reported history of an anxiety or depressive disorder, respectively. Patient (SAQ, FaCE) and clinician (Sunnybrook, eFaCE) scores were correlated (Pearson's r 0.223–0.294, p < 0.05). Upon adjusting for CES-D/FNAES, correlations between most patient and clinician metrics became stronger. As CES-D and FNAES worsened, patient–clinician correlations weakened.
Conclusions: Depression and appearance anxiety may affect patient reporting of synkinesis severity. Worse mental health scores may decorrelate patient and clinician synkinesis assessments.
Get full access to this article
View all available purchase options and get full access to this article.
References
1. Beurskens CH, Oosterhof J, Nijhuis-van der Sanden MW. Frequency and location of synkineses in patients with peripheral facial nerve paresis. Otol Neurotol. 2010;31(4):671–675.
2. Moran CJ, Neely JG. Patterns of facial nerve synkinesis. Laryngoscope. 1996;106(12 Pt 1):1491–1496.
3. Celik M, Forta H, Vural C. The development of synkinesis after facial nerve paralysis. Eur Neurol. 2000;43(3):147–151.
4. Bratzlavsky M, vander Eecken H. Altered synaptic organization in facial nucleus following facial nerve regeneration: an electrophysiological study in man. Ann Neurol. 1977;2(1):71–73.
5. Crumley RL. Mechanisms of synkinesis. Laryngoscope. 1979;89(11):1847–1854.
6. Salles AG, da Costa EF, Ferreira MC, do Nascimento Remigio AF, Moraes LB, Gemperli R. Epidemiologic overview of synkinesis in 353 patients with longstanding facial paralysis under treatment with botulinum toxin for 11 years. Plast Reconstr Surg. 2015;136(6):1289–1298.
7. Mehta RP, Hadlock TA. Botulinum toxin and quality of life in patients with facial paralysis. Arch Facial Plast Surg. 2008;10(2):84–87.
8. Escalante DA, Malka RE, Wilson AG, et al. Determining the prognosis of Bell's palsy based on severity at presentation and electroneuronography. Otolaryngol Head Neck Surg. 2022;166(1):151–157.
9. Fuzi J, Taylor A, Sideris A, Meller C. Does botulinum toxin therapy improve quality of life in patients with facial palsy? Aesthetic Plast Surg. 2020;44(5):1811–1819.
10. Saadi R, Shokri T, Schaefer E, Hollenbeak C, Lighthall JG. Depression rates after facial paralysis. Ann Plast Surg. 2019;83(2):190–194.
11. Nellis JC, Ishii M, Byrne PJ, Boahene KDO, Dey JK, Ishii LE. Association among facial paralysis, depression, and quality of life in facial plastic surgery patients. JAMA Facial Plast Surg. 2017;19(3):190–196.
12. Volk GF, Hesse S, Geißler K, et al. role of body dysmorphic disorder in patients with postparalytic facial synkinesis. Laryngoscope. 2021;131(9):E2518–E2524.
13. Bruins TE, van Veen MM, Mooibroek-Leeuwerke T, Werker PMN, Broekstra DC, Dijkstra PU. Association of socioeconomic, personality, and mental health factors with health-related quality of life in patients with facial palsy. JAMA Otolaryngol Head Neck Surg. 2020;146(4):331–337.
14. Pouwels S, Sanches EE, Chaiet SR, et al. Association between duration of peripheral facial palsy, severity, and age of the patient, and psychological distress. J Plast Reconstr Aesthet Surg. 2021;74(11):3048–3054.
15. Bruins TE, van Veen MM, Werker PMN, Dijkstra PU, Broekstra DC. Associations between clinician-graded facial function and patient-reported quality of life in adults with peripheral facial palsy: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2021;147(8):717–728.
16. van Veen MM, Quatela O, Tavares-Brito J, et al. Patient-perceived severity of synkinesis reduces quality of life in facial palsy: a cross-sectional analysis in 92 patients. Clin Otolaryngol. 2019;44(3):483–486.
17. Krane NA, Genther D, Weierich K, et al. Degree of self-reported facial impairment correlates with social impairment in individuals with facial paralysis and synkinesis. Facial Plast Surg Aesthet Med. 2020. [Epub ahead of print];
18. Martino SC, Elliott MN, Kanouse DE, Farley DO, Burkhart Q, Hays RD. Depression and the health care experiences of Medicare beneficiaries. Health Serv Res. 2011;46(6 Pt 1):1883–1904.
19. Rist TM, Segars K, Oyer SL. Influence of subclinical anxiety and depression on quality of life and perception of facial paralysis. Facial Plast Surg Aesthet Med. 2023;25(1):27–31.
20. Mehta RP, Wernick RM, Hadlock TA. Validation of the synkinesis assessment questionnaire. Laryngoscope. 2007;117(5):923–926.
21. Kahn JB, Gliklich RE, Boyev KP, Stewart MG, Metson RB, McKenna MJ. Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale. Laryngoscope. 2001;111(3):387–398.
22. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.
23. Lundgren JD, Anderson DA, Thompson JK. Fear of Negative Appearance Evaluation Scale (FNAES) [Database Record]. APA PsycTests. 2004.
24. Banks CA, Bhama PK, Park J, Hadlock CR, Hadlock TA. Clinician-graded electronic facial paralysis assessment: The eFACE. Plast Reconstr Surg. 2015;136(2):223e–230e.
25. Ross BG, Fradet G, Nedzelski JM. Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg. 1996;114(3):380–386.
26. Spataro EA, Kandathil CK, Saltychev M, Olds CE, Most SP. Correlation of the standardized cosmesis and health nasal outcomes survey with psychiatric screening tools. Aesthet Surg J. 2020;40(12):1373–1380.
27. Sarwer DB, Crerand CE, Magee L. Body dysmorphic disorder in patients who seek appearance-enhancing medical treatments. Oral Maxillofac Surg Clin North Am. 2010;22(4):445–453.
28. Sarwer DB, Wadden TA, Pertschuk MJ, et al. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg. 1998;101:1644–1649.
29. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62:593–602.
Information & Authors
Information
Published In
Facial Plastic Surgery & Aesthetic Medicine
Copyright
Copyright 2024, American Academy of Facial Plastic and Reconstructive Surgery, Inc.
History
Published online: 3 April 2024
Topics
Authors
Authors' Contributions
Conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, validation, visualization, writing—original draft, and writing—review and editing by E.S.L. Data curation, formal analysis, investigation, methodology, project administration, resources, validation, visualization, writing—original draft, and writing—review and editing by N.G.D. Conceptualization, data curation, investigation, methodology, resources, validation, visualization, supervision, writing—original draft, and writing—review and editing by A.S.O. Methodology, resources, validation, supervision, statistical analysis, and writing—review and editing by N.I.C. Conceptualization, data curation, investigation, methodology, project administration, resources, validation, visualization, supervision, writing—original draft, and writing—review and editing by P.N.P., S.J.S., and S.F.Y.
Author Disclosure Statement
No relevant disclosures to report. Unrelated to this project, N.I.C. receives grant support from the Burroughs Wellcome Fund and the NCI.
Funding Information
No funding was received for this article. All funding for this study was provided by the Vanderbilt Department of Otolaryngology/Head & Neck Surgery.
Metrics & Citations
Metrics
Citations
Export Citation
Export citation
Select the format you want to export the citations of this publication.
View Options
Get Access
Access content
To read the fulltext, please use one of the options below to sign in or purchase access.⚠ Society Access
If you are a member of a society that has access to this content please log in via your society website and then return to this publication.