| This study consists of four parts:Part one:Development and Precision Measuring of the Three-dimensional Dynamic Quantitative Analysis System for Facial MotionFacial three-dimensional dynamic quantitative analysis system consists of three parts:data collection, data processing and output, and fixation system. The data collection part is composed of six near-infrared array camera (frequency of 60 frames /sec) placed in symmetrical "L" shape. Controlled by multi-way synchronization controller, cameras captured motions simultaneously. The customized facial motion capture software is the core of the data processing part. The fixation part consists of a fixing head frame and an integrated fixed chair. The fixation system is mounted to mastoids and the occipital protrusion, which maintain the system relatively static to the skull and not affect the facial movements of the subject. Three markers are placed in the front tip of the system. Once the process of measuring is started, CCD cameras capture the reflected light of subjects under the control of multi-channel synchronous controller. Then the customized software calculate online and reconstruction and analyze offline.The result of acceleration test measurement:maximum error 0.0058m/s, average error 0.003026m/s, acceleration measurement error is 0.000135m/s2.Part two:Factors Influencing the Parameters of Three-dimensional Dynamic Quantitative AnalysisObjective:This part aimed at assessing the application of the three-dimensional dynamic system in facial paralysis patients and exploring the factors that affect the measurement results.Methods:We continuously collected 76 cases of unilateral facial paralysis. The mean age was 42.8 ± 14.3 year-old. Measurement process:cleansing → marking → adhesive→ training and system setup. Using the SFGS score as a control variable, partial correlation analysis was performed to calculate the correlation between age and healthy side parameters. Using the ENoG as a control variable, partial correlation analysis was performed to calculate the correlation between age and the paralyzed side parameters. Independent samples t test was used to compare healthy side parameters between sexes. Comparative analysis of variance was used to compare paralyzed side parameters between sexes.Result:1. Healthy side static parameters. Nasolabial-mouth corner spacing (r= 0.517) positively correlated with age. The canthal angle was negatively correlated with age (r =-0.424). In addition to laugh angle, the remaining parameters were significantly different between males and females (P<0.05). Moreover, except for the palpebral fissure height and canthal angle, the rest parameters are all larger in males. All the parameters except for laugh angle were significantly different between paralyzed patients and normal volunteers (P<0.05).2. Healthy side dynamic parameters. The maximum moving velocity of eyebrow midpoint (r=-0.428), the midpoint of the upper eyelid (r=-0.495) and paranasal point (r=-0.471) was negatively correlated with age. Maximum moving velocity and distance of eyebrow midpoint, maximum velocity and acceleration of upper eyelid point were all statistically larger in males than in females. Compared with healthy subjects, the dynamic parameters including the maximum moving velocity of the upper eyelids, the maximum velocity of eyebrow midpoint, maximum velocity and acceleration of paranasal point, maximum moving distance and velocity of mouth corner were all statistically different.3. Paralyzed side static parameters. Nasolabial-mouth corner spacing (r= 0.538), mouth corners spacing (r= 0.353) positively correlated with age (r= 0.538). Canthal angle (r=-0.349) was negatively correlated with age. Except for palpebral fissure height, all parameters were significantly different between males and females (P <0.05). However, no significant difference of symmetry ratio was found between males and females (P> 0.05).4. Paralyzed side dynamic parameters. The maximum velocity of eyebrow midpoint and upper eyelid midpoint of was negatively correlated with age. The rest affected dynamic parameters were not significantly correlated with age. The maximum velocity of eyebrow midpoint, maximum distance and velocity of mouth corner were significantly larger in males than in females (P<0.05).CONCLUSION:The three-dimensional dynamic system was a non-invasive and quick measuring system. Some facial parameters changed with age, which might cause additional effect on paralyzed faces. The majority of the parameters were larger in males than in females, but facial paralysis might reduce this difference.Part Three:Correlations and Prognostic Values of Different Facial Paralysis Evaluation SystemsObjective:This part aimed at comparing the correlations and prognostic values of different facial paralysis evaluation systems.Method:(1) We recruited 50 patients with unilateral facial paralysis. An integrated evaluation of facial paralysis was performed for each patient. The integrated evaluation included subjective grading systems, FaCE self-evaluation questionnaire, electromyography test and three-dimensional objective measurement. Then regional and gross symmetry ratios (SRs) of different parameters were calculated. The symmetry ratio (SRs) were then compared with other systems.(2) We continuously recruited 37 cases of acute (<1 month) facial paralysis patients with 6 patients (16%) Censored. An integrated evaluation of facial paralysis as above was performed for each patient. All patients were followed up for at least six months after the onset of facial paralysis.Result:1. Inter-static index with the subjective evaluation system was no significant correlation (P> 0.05). The SRs of the maximum moving distance (MMD) were most strongly correlated with regional subjective grading systems, followed by the SRs of the maximum moving velocity (MMV). The SRs of the maximum moving acceleration (MMA) were either poorly correlated or uncorrelated with the subjective grading systems. Only the items concerning regional motions in FaCE scale was correlated with 3D ASFM. Besides, the overall correlation with blink reflex was stronger than ENoG. The correlation with amplitude of blink response was stronger than the correlation with latency. And when compared with ENoG, the the maximum movement of each marker possessed larger correlation.2. Multiple regression analysis was performed to find the best prognostic indicators. (1)<30days:ENoG was the best prognostic indicator. The prediction formula is y= 113.527-60.558x, y is the SFGS score after six months, while x is the proportion of facial nerve degeneration detected by ENoG. (2) 31-60 days:SFGS score (x1) and three-dimensional dynamic measurement score (x2) shared the best prognostic value. The prediction formula is y= 19.202+0.557x1+0.531x2.CONCLUSION:The parameters of three-dimensional dynamic system had a good correlation with traditional grading systems. In acute facial paralysis, electrophysiological examination was the best predictor of the prognosis of facial paralysis. After one month, the combination of SFGS and three-dimensional dynamic subjective evaluation was the best prognosis predictor. |
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