Ross et al developed the Facial Grading System as a easily administered and sensitive grading system for injury to the facial nerve. This can be used for both initial evaluation and for monitoring the patient over time. The system was developed at the Sunnybrook Health Science Centre in Toronto, Canada.
Components:
(1) resting symmetry score: affected side compared to normal side
(2) voluntary movement score: degree of muscle excursion compared to normal side
(3) synkinesis score: involuntary muscle contractions associated with each expression
Parameter |
Finding (only 1 scored) |
Points |
---|---|---|
eye |
normal |
0 |
|
narrow |
1 |
|
wide |
1 |
|
eyelid surgery |
1 |
cheek (naso-labial fold) |
normal |
0 |
|
less pronounced |
1 |
|
more pronounced |
1 |
|
absent |
2 |
mouth |
normal |
0 |
|
corner drooped |
1 |
|
corner pulled up |
1 |
|
corner pulled out |
1 |
resting symmetry score =
= (SUM(points for all 3 parameters)) * 5
Voluntary Movement |
Finding |
Points |
---|---|---|
forehead wrinkle |
no movement (unable to initiate) |
1 |
|
initiates slight movement |
2 |
|
initiates movement with mid excursion |
3 |
|
almost complete |
4 |
|
complete |
5 |
gentle eye closure |
no movement (unable to initiate) |
1 |
|
initiates slight movement |
2 |
|
initiates movement with mid excursion |
3 |
|
almost complete |
4 |
|
complete |
5 |
open mouth smile |
no movement (unable to initiate) |
1 |
|
initiates slight movement |
2 |
|
initiates movement with mid excursion |
3 |
|
almost complete |
4 |
|
complete |
5 |
snarl |
no movement (unable to initiate) |
1 |
|
initiates slight movement |
2 |
|
initiates movement with mid excursion |
3 |
|
almost complete |
4 |
|
complete |
5 |
lip pucker |
no movement (unable to initiate) |
1 |
|
initiates slight movement |
2 |
|
initiates movement with mid excursion |
3 |
|
almost complete |
4 |
|
complete |
5 |
voluntary movement score =
= (SUM(points for all 5 movements)) * 4
Parameter |
Finding |
Points |
---|---|---|
forehead wrinkle |
none |
0 |
|
mild |
1 |
|
moderate |
2 |
|
severe |
3 |
gentle eye closure |
none |
0 |
|
mild |
1 |
|
moderate |
2 |
|
severe |
3 |
open mouth smile |
none |
0 |
|
mild |
1 |
|
moderate |
2 |
|
severe |
3 |
snarl |
none |
0 |
|
mild |
1 |
|
moderate |
2 |
|
severe |
3 |
lip pucker |
none |
0 |
|
mild |
1 |
|
moderate |
2 |
|
severe |
3 |
synkinesis score =
= (SUM(points for all 5 movements))
composite score =
= (voluntary movement score) - (resting symmetry score) – (synkinesis score)
Interpretation:
• minimum resting symmetry score: 0
• maximum resting symmetry score: 20
• minimum voluntary movement score: 20
• maximum voluntary movement score: 100
• minimum synkinesis score: 0
• maximum synkinesis score: 15
• minimum composite score: theoretically –15, probably 0 in practice
• maximum composite score: 100
• The higher the score, the better the functionality.
Performance:
• The authors found it sensitive to detect clinically important change over time or with treatment.
Limitation:
• Bilateral injuries to the facial nerve would not allow comparison between the affected and normal sides. Fortunately this is rare.
Specialty: Neurology, Emergency Medicine, Surgery, general, Otolaryngology
ICD-10: ,