Toward a Universal, Automated Facial Measurement Tool in Facial Reanimation

Figure 1. Photograph illustrating 7 relevant distances in facial paralysis. Lines represent (from top to bottom) top edge of eyebrow in midpupillary line (MPL), margin of upper eyelid in MPL, margin of lower eyelid in MPL, alar base, midupper lip position, oral commissure position, and midlower lip position. Horizontal black lines indicate height of these landmarks on the healthy side, and solid red lines indicate their position on the paralyzed side. The vertical lines represent facial midline (based on bisection of the interpupillary line) (black) and the actual center of the philtrum (red). A, Resting brow ptosis. B, Superior eyelid malposition. C, Inferior eyelid malposition. D, Nasal base ptosis. E, Midupper eyelip ptosis. F, Oral commissure malposition. G, Philtral deviation.

Figure 2. Graphic interface for the Facial Assessment by Computer Evaluation (FACE) program, which illustrates tabs to outline iris diameter and a pull-down menu specific to the parameters of interest.

Figure 3. Two patients with right facial paralysis performing the 7 standard expressions. Left: flaccid paralysis. Right: hypertonic paralysis. Note the difference in function based on the absence (left) or presence (right) of synkinesis.

Figure 4. Graph illustrating matched agreement between the 2 methods of determining oral commissure excursion with smiling. FACE indicates Facial Assessment by Computer Evaluation. Error bars indicate SD.

Figure 5. Graph illustrating the statistically significant difference in time it takes to analyze a resting photograph for 7 facial landmarks (P < .001). The Facial Assessment by Computer Evaluation (FACE) method took approximately one-tenth the time of the Photoshop measurements. Error bars indicate SD.

Figure 6. Graphs demonstrating the sensitivity of the Facial Assessment by Computer Evaluation (FACE) method in distinguishing between a diseased population and healthy volunteers. A, Brow ptosis at rest between facial paralysis patients and individuals with normal facial animation. B, Number of millimeters of commissure excursion with smiling. Note that the facial paralysis group shows essentially no commissure excursion, whereas individuals with normal facial animation show literature-matched values. Error bars indicate SD.