Sydney Facial Nerve Clinic: experience of a multidisciplinary team. 2020

Raymond Hayler, and Jonathan Clark, and Glen Croxson, and Susan Coulson, and Gazi Hussain, and Quan Ngo, and Sydney Ch'ng, and Tsu-Hui Hubert Low
Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.

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. 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). 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. 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.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010348 Patient Care Team Care of patients by a multidisciplinary team usually organized under the leadership of a physician; each member of the team has specific responsibilities and the whole team contributes to the care of the patient. Health Care Team,Interdisciplinary Health Team,Medical Care Team,Multidisciplinary Care Team,Multidisciplinary Health Team,Healthcare Team,Care Team, Health,Care Team, Medical,Care Team, Multidisciplinary,Care Team, Patient,Care Teams, Health,Care Teams, Patient,Health Care Teams,Health Team, Interdisciplinary,Health Team, Multidisciplinary,Healthcare Teams,Interdisciplinary Health Teams,Medical Care Teams,Multidisciplinary Care Teams,Multidisciplinary Health Teams,Patient Care Teams,Team, Health Care,Team, Healthcare,Team, Interdisciplinary Health,Team, Medical Care,Team, Multidisciplinary Care,Team, Multidisciplinary Health,Team, Patient Care,Teams, Interdisciplinary Health
D005154 Facial Nerve The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and SALIVARY GLANDS, and convey afferent information for TASTE from the anterior two-thirds of the TONGUE and for TOUCH from the EXTERNAL EAR. Cranial Nerve VII,Marginal Mandibular Branch,Marginal Mandibular Nerve,Seventh Cranial Nerve,Nerve VII,Nerve of Wrisberg,Nervus Facialis,Nervus Intermedius,Nervus Intermedius of Wrisberg,Cranial Nerve VIIs,Cranial Nerve, Seventh,Facial Nerves,Mandibular Nerve, Marginal,Mandibular Nerves, Marginal,Marginal Mandibular Nerves,Nerve VIIs,Nerve, Facial,Nerve, Marginal Mandibular,Nerve, Seventh Cranial,Nerves, Marginal Mandibular,Nervus Faciali,Seventh Cranial Nerves,Wrisberg Nerve,Wrisberg Nervus Intermedius
D005158 Facial Paralysis Severe or complete loss of facial muscle motor function. This condition may result from central or peripheral lesions. Damage to CNS motor pathways from the cerebral cortex to the facial nuclei in the pons leads to facial weakness that generally spares the forehead muscles. FACIAL NERVE DISEASES generally results in generalized hemifacial weakness. NEUROMUSCULAR JUNCTION DISEASES and MUSCULAR DISEASES may also cause facial paralysis or paresis. Facial Palsy,Hemifacial Paralysis,Facial Palsy, Lower Motor Neuron,Facial Palsy, Upper Motor Neuron,Facial Paralysis, Central,Facial Paralysis, Peripheral,Facial Paresis,Lower Motor Neuron Facial Palsy,Upper Motor Neuron Facial Palsy,Central Facial Paralyses,Central Facial Paralysis,Facial Palsies,Facial Paralyses, Central,Facial Paralyses, Peripheral,Palsies, Facial,Palsy, Facial,Paralyses, Central Facial,Paralyses, Facial,Paralyses, Hemifacial,Paralysis, Central Facial,Paralysis, Facial,Paralysis, Hemifacial,Paralysis, Peripheral Facial,Pareses, Facial,Paresis, Facial,Peripheral Facial Paralysis
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D020330 Bell Palsy A syndrome characterized by the acute onset of unilateral FACIAL PARALYSIS which progresses over a 2-5 day period. Weakness of the orbicularis oculi muscle and resulting incomplete eye closure may be associated with corneal injury. Pain behind the ear often precedes the onset of paralysis. This condition may be associated with HERPESVIRUS 1, HUMAN infection of the facial nerve. (Adams et al., Principles of Neurology, 6th ed, p1376) Bell's Palsy,Facial Neuropathy, Inflammatory, Acute,Facial Paralysis, Idiopathic,Herpetic Facial Paralysis,Acute Idiopathic Facial Neuropathy,Acute Inflammatory Facial Neuropathy,Facial Neuropathy, Idiopathic Acute,Idiopathic Acute Facial Neuropathy,Inflammatory Facial Neuropathy, Acute,Bell Palsies,Bell's Palsies,Bells Palsy,Facial Paralyses, Herpetic,Facial Paralyses, Idiopathic,Facial Paralysis, Herpetic,Herpetic Facial Paralyses,Idiopathic Facial Paralyses,Idiopathic Facial Paralysis,Palsies, Bell,Palsies, Bell's,Palsy, Bell,Palsy, Bell's,Paralyses, Herpetic Facial,Paralyses, Idiopathic Facial,Paralysis, Herpetic Facial,Paralysis, Idiopathic Facial

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