Page 117 - HHR-HNR 2.0

palsy, which is probably an inflammatory demyelinating impairment of the nervus facialis dominated by a lymphocytic infiltrate. The actual cause of peripheral facial palsy is idiopathic (Mamoli, Neumann et al. 1977).\u000DFacial nerve palsy can be caused by an infection, tumour, trauma or surgical procedure (Beurskens, van Rossum-Herraets et al. 1998). The incidence in the Netherlands is 2:10,000 (Devriese, Schumacher et al. 1990). Facial palsy presents itself by a drooping face, reduced ability to move the facial muscles and/or involuntary movements of mouth and/or eye (synkinesis). Furthermore, facial palsy hampers not only facial expression, but also functions such as eating, drinking, speaking and emotional expression (De Swart, Verheij et al. 2003, Beurskens and Heymans 2006).\u000D5.3.5.1 Effects of head and neck oncology treatment\u000DWithin the head and neck rehabilitation programme only patients with facial nerve palsy that is caused by a tumour will be seen. In the case of a tumour in the head and neck area it can be necessary to sacrifice (part of) the peripheral nervus facialis to allow for the excision of the tumour (usually tumours of the parotis) with a safe margin. This may cause disruption of facial expression. If the operation causes damage to the mandibular branch, loss of tone occurs in the perioral muscles which, depending on the elasticity of the facial muscles, leads to drooping of the mouth towards the healthy side and problems with speaking, eating and drinking. Damage to the frontal branch leads to brow ptosis; damage to the marginal branch leads to lower lip dysfunction (guideline head and neck tumours 2015, https://www.radiologen.nl/268/8019/neuro-en-hoofdhalsradiologie/richtlijn-hoofd- halstumoren-2015.html. Also, facial nerve palsy may be caused by tumour in growth in the facial nerve.\u000D5.3.5.2. Screening methods for facial palsy\u000DTo assess the type of facial paresis a grading system can be used. Two commonly used grading systems are the House-Brackmann grading and the Sunnybrook Facial Grading System (House 1983, Ross, Fradet et al. 1996). Both have been translated into Dutch. The House-Brackmann grading is a grading system in which grade I indicates normal functioning, grade II mild dysfunction, grade III moderate dysfunction, grade IV moderately severe dysfunction, grade V severe dysfunction and grade VI total palsy. With each grading a number of attributes are listed with reference to the overall function, resting symmetry and symmetry during movement (House 1983).\u000DThe Sunnybrook Facial Grading System provides scoring for a.o. resting symmetry of the eye, cheek and mouth, voluntary excursion of the facial muscles, and synkinesis (level of involuntary muscle contraction). The three scores are then added up to arrive at a composite score (Ross, Fradet et al. 1996). The lower the grade/score, the better the function; that is, the more facial symmetry there will be.\u000DSince facial nerve palsy can have a negative impact on quality of life, several questionnaires have been developed to screen for this. The Facial Disability Index (FDI) is a self-report questionnaire containing 10 items (VanSwearingen and Brach 1996). These are divided into Physical function (item 1-5, with a score of 0-5, whereby 5= no difficulty and 0= difficulty of other reasons) and Social/well-being function (item 6=10, with a scale of 1-6, whereby 1= all of the time and 6= none of the time, excepting item. Please note: for item 6 the anwer options have been reversed). The FDI score is made up of the Physical function score ((total score of items 1-5 \u2013 number of items answered)/number of questions answered) * (100/4)) and the Social/well-being function score ((total score of items 6-10 \u2013 numbers of\u000D116\u000D