Facial Nerve Grading Systems

Abstract

Clinicians require a reliable and sensitive facial grading system to determine the status of facial nerve function postinjury as well as to evaluate the efficacy of treatment outcomes. The method of assessment should be easy to administer, reproducible, clinically relevant, and require little time and expense. The grading system should be sufficiently sensitive to detect changes over time or following treatment. The lack of a universally accepted grading system frequently does not allow meaningful comparison when assessing the effectiveness of treatment protocols for facial nerve injury. The aim of this article is to review most of the previously published facial grading systems. It is our contention that a grading system developed and currently used within our institution appropriately addresses the needs as well as many of the deficiencies of most other grading systems.

Facial muscle activation patterns in healthy male humans: A multi-channel surface EMG study

“…The approach of this study was to investigate a wide diversity of facial movements including the ones performed by facial grading systems (Stennert et al, 1977;Murty et al, 1994;Ross et al, 1996;Chee and Nedzelski, 2000) to determine, firstly, which one is able to activate specific facial muscles and, secondly, which is more easily accomplished by the subjects. The ability to realize a distinct facial movement was different between subjects which led to an unavoidable increase of the inter-and intra-individual variability in the associated SEMG patterns.…”

Contemporary Solutions for the Treatment of Facial Nerve Paralysis

“…On the paralyzed side, movement of the commissure and upper lip is noted along with accentuation of the nasolabial crease. A number of facial nerve grading systems are available for use, [5][6][7][8] and medical centers treating facial paralysis should have an objective testing method. Examination is completed with testing of the fifth cranial nerve (temporalis and masseter muscle palpation).…”

Quantitative Measurement of Evolution of Postparetic Ocular Synkinesis Treated with Botulinum Toxin Type A

“…4 The Sunnybrook Facial Grading System 4 is considered to be one of the best scales available because it not only provides an overall facial motility score but also quantifies the severity of postparetic synkinesis in different facial regions. [5][6][7][8][9][10] Recent years have seen the introduction of computerized systems that objectively quantify facial movements by analyzing static and dynamic face images. [10][11][12][13][14][15][16][17][18] Two of these systems were used to evaluate the clinical evolution of patients treated with botulinum toxin type A (Botox; Allergan, Inc., Irvine, Calif.) for postparetic synkinesis.…”