Reliability Between In-Person and Still Photograph Assessment of Facial Function in Facial Paralysis Using the eFACE Facial Grading System

Abstract

<b>Importance:</b> Assessing facial function using high-quality photographs would improve long-term and objective outcomes tracking in facial palsy, facilitate automated facial grading using artificial intelligence algorithms, and allow for remote follow up. <b>Objective:</b> To determine agreement between in-person and photographic electronic facial function scale (eFACE) assessments, and evaluate inter-rater reliability of photographic eFACE evaluation. <b>Design, Setting, and Participants:</b> Retrospective review of eFACE scores from in-person interviews and standardized photographs using the Massachusetts Eye and Ear (MEE) Standard Facial Palsy Dataset. <b>Main Outcomes and Measures:</b> eFACE total scores and subset scores determined by two experienced facial reanimation surgeons in person and from photographs. <b>Results:</b> Intraclass correlation coefficients for eFACE scores were 0.96 (95% CI 0.94 to 0.97) for total scores, 0.99 (95% CI 0.989 to 0.995) for static scores, 0.82 (95% CI 0.74 to 0.88) for dynamic scores, and 0.98 (95% CI 0.97 to 0.99) for synkinesis scores. Photographic and in-person scores had a mean difference of -0.64 (95% CI -2.05 to 0.77; <i>p</i> = 0.37) for total score, -1.58 (95% CI -4.22 to 1.05; <i>p</i> = 0.24) for the static subset, 0.14 (95% CI -1.70 to 1.97; <i>p</i> = 0.88) for the dynamic subset, and -1.11 (95% CI -3.09 to 0.86; <i>p</i> = 0.26) for the synkinetic subset. Bland-Altman analysis showed no trend for increasing differences in total score or subset scores. <b>Conclusions:</b> eFACE assessment obtained via photographs exhibits excellent inter-rater reliability and strong agreement with in-person assessment, demonstrating facial symmetry in facial palsy patients can be monitored using standardized frontal photographs.