Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May;90(5):856-860.
doi: 10.1111/ans.15782. Epub 2020 Mar 4.

Sydney Facial Nerve Clinic: experience of a multidisciplinary team

Raymond Hayler  1   2 , Jonathan Clark  1   2 , Glen Croxson  2 , Susan Coulson  2   3 , Gazi Hussain  2   4 , Quan Ngo  2   5 , Sydney Ch'ng  1   2   6   7 , Tsu-Hui Hubert Low  1   2
Affiliations

Sydney Facial Nerve Clinic: experience of a multidisciplinary team

Raymond Hayler et al. ANZ J Surg. 2020 May.

Abstract

Background: The Sydney Facial Nerve Clinic (SFNC) is a multidisciplinary clinic established in 2015, consisting of surgeons (otolaryngologists, head and neck and plastics/reconstructive), physiotherapists and speech pathologists.

Methods: We reviewed patients who attended the SFNC in the first 3 years and who had their symptoms recorded using the Facial Disability Index, and clinical staging recorded utilising the House-Brackmann (HB) score, Sydney Facial Nerve Score and Sunnybrook Facial Grading System (SFGS).

Results: Between May 2015 and June 2018, 145 patients attended the clinic. Mean age was 44.6 ± 17.3 years with 94 (64.8%) females. Most referrals came from general practitioners (n = 75, 54.5%). The most common aetiology was iatrogenic injury (n = 55, 37.9%), followed by Bell's palsy (n = 48, 33.1%), congenital (n = 11, 7.6%), herpes zoster oticus (n = 9, 6.2%), trauma (n = 9, 6.2%) and other (n = 13, 9.0%). The median HB was 4, the mean Sydney score 7.3/15 and the mean SFGS was 45/100. Patients with iatrogenic causes had the worse facial nerve scoring in HB, Sydney and SFGS. Patients with congenital aetiology reported the least symptoms on Facial Disability Index (P < 0.001). Most patients were recommended non-surgical management (n = 92, 64.3%); 51 (35.7%) were referred for botulinum toxin + facial physiotherapy, 25 (17.2%) for physiotherapy alone, seven (4.9%) for botulinum toxin alone and nine (6.3%) for conservative management. Fifty-one patients (35.7%) were recommended surgery, generating 75 procedures; 24 oculoprotective, 22 static, 12 gracilis transfers, 10 temporalis myoplasties and seven nerve transfers.

Conclusion: Iatrogenic injuries are the most common presentation for this clinic and have a more severe clinical presentation. Most patients presenting to the SFNC were managed non-surgically.

Keywords: facial nerve; multidisciplinary clinic.

PubMed Disclaimer

References

    1. Gordin E, Lee TS, Ducic Y, Arnaoutakis D. Facial nerve trauma: evaluation and considerations in management. Craniomaxillofac. Trauma Reconstr. 2015; 8: 1-13.
    1. Coulson SE, O'Dwyer NJ, Adams RD, Croxson GR. Expression of emotion and quality of life after facial nerve paralysis. Otol. Neurotol. 2004; 25: 1014-9.
    1. 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: 190-6.
    1. Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process. J. Gen. Intern. Med. 2000; 15: 626-31.
    1. Soukup T, Lamb BW, Arora S, Darzi A, Sevdalis N, Green JS. Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature. J. Multidiscip. Healthc. 2018; 11: 49-61.

LinkOut - more resources