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Original Investigation |

Asymmetry of Facial Mimicry and Emotion Perception in Patients With Unilateral Facial Paralysis

Sebastian Korb, PhD1; Adrienne Wood, MS2; Caroline A. Banks, MD3; Dasha Agoulnik3; Tessa A. Hadlock, MD4; Paula M. Niedenthal, PhD2
[+] Author Affiliations
1Neuroscience Area, International School for Advanced Studies (SISSA), Trieste, Italy
2Department of Psychology, University of Wisconsin, Madison
3Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
4Division of Facial Plastic and Reconstructive Surgery, Facial Nerve Center, Boston, Massachusetts
JAMA Facial Plast Surg. 2016;18(3):222-227. doi:10.1001/jamafacial.2015.2347.
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Importance  The ability of patients with unilateral facial paralysis to recognize and appropriately judge facial expressions remains underexplored.

Objective  To test the effects of unilateral facial paralysis on the recognition of and judgments about facial expressions of emotion and to evaluate the asymmetry of facial mimicry.

Design, Setting, and Participants  Patients with left or right unilateral facial paralysis at a university facial plastic surgery unit completed 2 computer tasks involving video facial expression recognition. Side of facial paralysis was used as a between-participant factor. Facial function and symmetry were verified electronically with the eFACE facial function scale

Exposures  Across 2 tasks, short videos were shown on which facial expressions of happiness and anger unfolded earlier on one side of the face or morphed into each other. Patients indicated the moment or side of change between facial expressions and judged their authenticity.

Main Outcomes and Measures  Type, time, and accuracy of responses on a keyboard were analyzed.

Results  A total of 57 participants (36 women and 21 men) aged 20 to 76 years (mean age, 50.2 years) and with mild left or right unilateral facial paralysis were included in the study. Patients with right facial paralysis were faster (by about 150 milliseconds) and more accurate (mean number of errors, 1.9 vs 2.5) to detect expression onsets on the left side of the stimulus face, suggesting anatomical asymmetry of facial mimicry. Patients with left paralysis, however, showed more anomalous responses, which partly differed by emotion.

Conclusions and Relevance  The findings favor the hypothesis of an anatomical asymmetry of facial mimicry and suggest that patients with a left hemiparalysis could be more at risk of developing a cluster of disabilities and psychological conditions including emotion-recognition impairments.

Level of Evidence  3.

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Figure 1.
Mean (SE) Ratings of Authenticity in Phase 1 of the Onset Asymmetry (OAS) Task Across Paralysis-Side, OAS-Side, and Emotion

Note that although the effect was not statistically significant, patients with a right-sided paralysis behaved similarly to healthy nonparalyzed persons4 in that they rated expressions starting on the left side of the stimulus face as being more authentic (higher score) than those starting on the right side. Patients with a left-sided paralysis (A), on the other hand, showed a more anomalous pattern of authenticity ratings than those with right-sided paralysis (B) across OAS-side.

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Figure 2.
Mean (SE) Number of Errors in Phase 2 of the Onset Asymmetry (OAS) Task Across Paralysis-Side, OAS-Side, and Emotion

A, Patients with left-sided facial paralysis made more errors for happy expressions starting on the left side of the stimulus face and for angry expressions starting on the right. B, In contrast, patients with right-sided facial paralysis were more accurate in detecting the onset of facial expressions of both happiness and anger starting on the left side of the stimulus face.

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Figure 3.
Mean (SE) Response Times in the Offset Task Across Paralysis-Side and Emotion

This interaction, though statistically insignificant (P = .07), suggests that patients with right-sided facial paralysis perceive changes between facial expressions more rapidly, both in angry-to-happy and happy-to-angry trials. In contrast, patients with left-sided paralysis perceive changes more slowly, specifically in angry-to-happy trials.

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