Facial Nerve Grading Instruments

Fattah, Adel; Gurusinghe, A.D.R.; Gavilán, Javiér; Hadlock, Tessa A.; Marcus, Jeff; Marres, H.A.M.; Nduka, Charles; Slattery, William H.; Snyder‐Warwick, Alison K.

doi:10.1097/prs.0000000000000905

Cited by 213 publications

(119 citation statements)

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“…This study showed that a modified version of the S-FGS-the mS-FGS, including evaluation of the DLI and DAO muscles-significantly improved the overall assessment of facial nerve dysfunctions following parotidectomy. Several other instruments are available to clinically assess facial nerve impairments 9,15,16 . The most popular is the House-Brackmann Facial Nerve Grading System (HB), which grades the facial nerve function in six levels 17 .…”

Section: Discussionmentioning

confidence: 99%

“…It offers a regional assessment, considering the face at rest and during movements, beyond the synkinesis, and with good intraobserver and interobserver reliability. 9 The five standard expressions cover the temporal, zygomatic and buccal branches. However, muscles predominantly innervated by the MMB are not included in the system, limiting the test's use for post-parotidectomy assessment (Figure 3).…”

Section: Discussionmentioning

confidence: 99%

“…The Post-Parotidecomy Facial Nerve Grading System was specifically developed for this purpose 26 , but its applicability and efficiency have not yet been tested by other authors. On the other hand, Fattah et al 9 , on behalf of the Sir Charles Bell Society, "…recommend widespread adoption of the Sunnybrook Facial Grading Scale as the current standard in reporting outcomes of facial nerve disorders", based on their systematic review of 19 facial nerve grading scales. 9 This excellent tool, however, needs adaptation to better appraise parotidectomyinduced facial dysfunction by including the MMB evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were periodically reassessed, following the same protocol. The mean number of physical therapy appointments was 5.40 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11), and the median interval time between the first and last facial evaluations was 133 days (IQR: 53-269). The final analysis involved 50 patients.…”

Section: Methodsmentioning

confidence: 99%

“…The Sunnybrook Facial Grading System (S-FGS) was recently recommended as the standard tool for assessing facial nerve dysfunctions 9 . However, the muscles innervated by the MMB are not considered by this instrument.…”

mentioning

confidence: 99%

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Parotidectomy-related facial nerve lesions: proposal for a modified Sunnybrook Facial Grading System

Costa

Maranhão-Filho

Santos

et al. 2019

Arq. Neuro-Psiquiatr.

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Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. Objective To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. Methods We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. Results The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. Conclusion The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Parotidectomy-related facial nerve lesions: proposal for a modified Sunnybrook Facial Grading System

Costa

Maranhão-Filho

Santos

et al. 2019

Arq. Neuro-Psiquiatr.

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Antiviral Agents Added to Corticosteroids for Early Treatment of Adults With Acute Idiopathic Facial Nerve Paralysis (Bell Palsy)

Sullivan

Daly

Gágyor³

2016

JAMA

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Emerging vs Time-Tested Methods of Facial Grading Among Patients With Facial Paralysis

Gaudin

Robinson

Banks

et al. 2016

JAMA Facial Plast Surg

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IMPORTANCE Most rehabilitation specialists and many facial reanimation surgeons use the Sunnybrook Facial Grading System (FGS) to measure and detect changes in facial function. The eFACE, an electronic and digitally graded facial measurement scale, was recently created to provide similar information to the Sunnybrook FGS, but with scaling uniformity across all categories of facial function, graphical outputs, and easy-to-use visual analog scales. OBJECTIVES To establish the correlation between the scores on the eFACE and the Sunnybrook FGS among patients with facial paralysis and to compare the reliability of the 2 scales. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of medical records identified 109 patients who were evaluated at a facial nerve center by physical therapists using the eFACE and the Sunnybrook FGS on the same day, between November 1, 2014, and May 31, 2015. The level of facial function predicted using the 2 scales was compared to study correlation between the scales. Data analysis was conducted from June 1 to September 1, 2015. MAIN OUTCOMES AND MEASURES Correlation between the Sunnybrook FGS and the eFACE grading scale. METHODS Two independent physical therapists evaluated patients using both the eFACE and the Sunnybrook FGS. Scores were compared and the Spearman rank correlation coefficient was calculated between the total scores and each of the 3 subscores, including static, dynamic, and synkinesis scores. The total Sunnybrook FGS synkinesis score (worst score, 15; perfect score, 0) and static score (worst score, 20; perfect score, 0) were normalized to a 100-point scale with the eFACE (perfect score, 100; worst score, 1). RESULTS eFACE scores ranged from 48 to 100, and Sunnybrook FGS scores ranged from 0 to 100. Among 109 patients, there was a moderately strong correlation between eFACE and Sunnybrook FGS scores in both total and subcategory scores. The Spearman rank correlation coefficient of the total eFACE and Sunnybrook FGS was 0.75 (r < 0.0001). For the static scores, the correlation coefficient was-0.71 (r < 0.0001). The correlation coefficients for the dynamic and synkinesis scores were 0.77 (r < 0.0001) and-0.78 (r < 0.0001), respectively. CONCLUSIONS AND RELEVANCE There is moderately good agreement between the Sunnybrook FGS and the eFACE. Given the ease of using the eFACE on mobile devices, as well as its additional functionality, it may represent a reasonable facial grading option across disciplines in the future. LEVEL OF EVIDENCE NA.

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Facial Nerve Grading Instruments

Cited by 213 publications

References 52 publications

Parotidectomy-related facial nerve lesions: proposal for a modified Sunnybrook Facial Grading System

Parotidectomy-related facial nerve lesions: proposal for a modified Sunnybrook Facial Grading System

Antiviral Agents Added to Corticosteroids for Early Treatment of Adults With Acute Idiopathic Facial Nerve Paralysis (Bell Palsy)

Emerging vs Time-Tested Methods of Facial Grading Among Patients With Facial Paralysis

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