How the world sees facial palsy patients
Reviewed by Aileen Lambert

This paper from Australia gives an insightful perspective on the impact of facial paralysis on patients, and may explain the well-documented poor quality of life scores in this patient group, particularly those ‘successfully reconstructed’ with surgery. It explores how the general public (i.e., ‘healthy oberservers’) view a stranger with facial paralysis. What is most interesting from a clinical viewpoint is that there is a difference in social perception depending on what muscle groups are affected, thus possibly directing reconstruction efforts to optimise those with the biggest impact. A hundred observers were shown five photographs, including one control and four different facial palsies and were asked eight questions (based on social attitude themes identified by patients themselves). All the paralysed faces were rated as ‘less normal’ than the control (statistically and clinically significant), with zygomatic/buccal paralysis as the most disfiguring compared with marginal or temporal palsies. Other attitudes that emerged were that the paralysed faces were less trustworthy, less intelligent, more distressed and needed to undergo correction. Fortunately for surgeons involved in facial reanimation surgery, it would appear from this study that the most important individual component of facial paralysis in terms of social attitude (zygomatic muscle supply) is also that prioritised functionally in the clinical setting to ensure eye closure. 

Social perception of morbidity in facial nerve paralysis.
Li MK, Niles N, Gore S, et al.
HEAD AND NECK
2016;38(8):1158-63.