Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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A Portable Handheld Facial-Grading Device for Unilateral Facial Paralysis Following Facial Reanimation Surgery: Reproducibility and Reliability
Eric M. Jablonka, MD, Ilya Shnaydman, MD, Peter J. Taub, MD, Elliott Rose, MD.
The Mount Sinai Hospital, New York, NY, USA.

PURPOSE:
The need to evaluate current facial reanimation surgical principles and techniques has lead the focus on the development of a device to objectively measure the quantitative degree of facial paralysis. We have developed the digitally based R* Facial Grading System (FGS) application for desktops and portable handheld devices (i.e., iPad) to conveniently measure smile restoration following reanimation surgery for unilateral facial paralysis. Our goal is to prove user reproducibility and reliability of our new system.
METHODS:
After taking a picture of a subject at rest and in full smile, the R* FGS software walks the user through calculating a global smile score, specific scores, and smile animation scores from specifically selected facial anatomic landmarks. Six surgical residents were selected to test the intra- & inter-user reproducibility and reliability of the R* FGS system. Each user performed 5 test trials on a mock patient of the subject’s face at rest and in full smile. Three users tested the R* FGS on a desktop computer while the other 3 users tested the R* FGS on an iPad.
RESULTS:
The iPad users had a completion time of 52 +/- 10.4 sec at trial 5. Average intra-user reproducibility for percent smile symmetry, lip spread, degree tilt and teeth show were 0.995 (+/- 0.001), 0.972 (+/- 0.010), 0.996 (+/- 0.002) and 0.997 (+/- 0.001), respectively. The inter-user reliabilities for the same parameters were 0.999, 0.993, 0.999 and 1.000, respectively. Although the desktop users had a longer completion time of 84.2 +/- 20 sec at trail 5, Average intra-user reproducibility for percent smile symmetry, lip spread, degree tilt and teeth show were 0.997 (+/- 0.002), 0.986 (+/- 0.004), 0.999 (+/- 0.0001) and 0.998 (+/- 0.001), respectively. The inter-user reliabilities for the same parameters were 0.999, 0.993, 0.999 and 0.999, respectively.
CONCLUSION:
Preliminary data suggests that the R* FGS is a reproducible and reliable reporting tool to measure the degree of smile restoration following reanimation surgery for unilateral facial paralysis. Our system allows retrospective photo-analysis from prior years by simply scanning to a desktop computer. Given that a majority of our patients reside away from our practice, our system also provides us the potential to monitor and measure patient progress through voice-over-IP software applications (i.e., Skype, FaceTime). The application is affordable, time efficient and can be conveniently used on a desktop or portable handheld device.


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