PubMed · 3344633
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A J Lees. 1988. Facial mannerisms and tics.. https://pubmed.ncbi.nlm.nih.gov/3344633/
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Assessment of infant pain is a pressing concern, especially within the context of neonatal intensive care where infants may be exposed to prolonged and repeated pain during lengthy hospitalization. In the present study the feasibility of carrying out the complete Neonatal Facial Coding System (NFCS) in real time at bedside, specifically reliability, construct and concurrent validity, was evaluated in a tertiary level Neonatal Intensive Care Unit (NICU). Heel lance was used as a model of procedural pain, and observed with n = 40 infants at 32 weeks gestational age. Infant sleep/wake state, NFCS facial activity and specific hand movements were coded during baseline, unwrap, swab, heel lance, squeezing and recovery events. Heart rate was recorded continuously and digitally sampled using a custom designed computer system. Repeated measures analysis of variance (ANOVA) showed statistically significant differences across events for facial activity (P < 0.0001) and heart rate (P < 0.0001). Planned comparisons showed facial activity unchanged during baseline, swab and unwrap, then increased significantly during heel lance (P < 0.0001), increased further during squeezing (P < 0.003), then decreased during recovery (P < 0.0001). Systematic shifts in sleep/wake state were apparent. Rise in facial activity was consistent with increased heart rate, except that facial activity more closely paralleled initiation of the invasive event. Thus facial display was more specific to tissue damage compared with heart rate. Inter-observer reliability was high. Construct validity of the NFCS at bedside was demonstrated as invasive procedures were distinguished from tactile. While bedside coding of behavior does not permit raters to be blind to events, mechanical recording of heart rate allowed for an independent source of concurrent validation for bedside application of the NFCS scale.
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BACKGROUND: Disorders of lower lip in facial expression are mostly caused by functional impairment of the marginal mandibular branch of the facial nerve. In a typical case, active exposure of the incisors of the mandible is not possible and the lip appears distorted towards the healthy side. The most frequent cause of a lesion of the marginal mandibular branch is iatrogenic injury during operations in the mandibular or parotid region. DIFFERENTIAL DIAGNOSIS: Functional disorders of the platysma, congenital hypoplasia or aplasia of the lower lip muscles, and defective healing following facial palsy may lead to a similar disorder which, however, must be differentiated from an isolated paralysis of the marginal mandibular branch. TREATMENT: In addition to inactivation of the nerve branch on the opposite side, several surgical procedures have been described to achieve not only aesthetic, but also functional rehabilitation of lower lip expression. The present review gives an overview on the causes, clinical appearance, diagnosis, differential diagnosis, and therapy of unilateral isolated paresis of the marginal mandibular branch of the facial nerve.