Key findings
The current study aimed to determine the true contribution of FaCE
subscales to overall facial palsy-specific quality of life. According to
our findings, social well-being and synkinesis are the most relevant
components of ‘overall’ facial palsy-related quality of life. Both
constructs are currently underestimated in the calculation of the FaCE
total score.
Our analysis shows that the social burden patients experience is the
most important component of ‘overall’ quality of life and is
underestimated in the FaCE total score. Our results suggest that almost
half of ‘overall’ facial palsy-related quality of life is socially
related. With this, our findings more closely reflect a different facial
palsy PROM: the Facial Disability Index (FDI), which consists of 10
questions evenly split between the physical and social domain.
Synkinesis, which is described in the facial comfort subscale, was found
to be the second most important component of ‘overall’ facial
palsy-related quality of life, and the only other statistically
significantly contributing subscale. In a previous study, synkinesis was
found to contribute significantly to the prediction of quality of
life.3 A high degree of synkinesis was also found to
be associated with “non-effective” self-reported emotional
expression.4 Synkinesis may thus reduce quality of
life by both causing physical discomfort and impairing social function,
and it should form a larger component of facial palsy-specific quality
of life assessment.
Surprisingly, eye comfort and lacrimal control were insignificant
predictors of overall quality of life. This is in line with previous
research suggesting that periocular muscle function is of low importance
in estimating quality of life.5 However, this is not
in line with our clinical expertise or the findings of other researchers
that the treatment of periocular complaints leads to a significant
improvement in total FaCE score.6 A possible
explanation for this could be that most patients in our sample already
received periocular treatment, and therefore no longer experience
periocular problems. This is especially plausible in our sample of
chronic facial palsy patients but requires further investigation.