Stennert developed a Secondary Defect Score for patients with facial nerve injury to identify complications of facial nerve paralysis. This can be used to monitor patients during the recovery phase and to assess the patient for residual disability.
Measures (scored):
(1) synkinesis (involuntary muscle contractions associated with each expression; indicate aberrant sprouting)
(2) muscle spasm
(3) lacrimation
(4) contractures
(5) crocodile tears (lacrimation while chewing or eating)
Additional measures (unscored since of little functional significance):
(6) hyperacusis
(7) impaired gustation (taste)
Areas to observe for synkinesis:
(1) forehead
(2) eye
(3) nasolabial sulcus
(4) corner of the mouth
(5) chin
|
Measure |
Finding |
Points |
|
synkinesis |
none |
0 |
|
|
present in 1 to 3 areas |
1 |
|
|
present in more than 3 areas |
2 |
|
spasm |
absent |
0 |
|
|
mild to moderate |
1 |
|
|
strongly present |
2 |
|
|
inconvenient |
3 |
|
lacrimation |
>= 30% of normal |
0 |
|
|
> 0% and < 30% of normal, with complete lid closure |
1 |
|
|
> 0% and < 30% of normal, with incomplete lid closure |
2 |
|
|
0% with complete lid closure |
2 |
|
|
0% with incomplete lid closure |
3 |
|
contractures |
absent |
0 |
|
|
present |
1 |
|
crocodile tears |
absent |
0 |
|
|
present |
1 |
after Figure 5, page 547, Adour et al (1977)
where:
• Assignments of points for lacrimation is based on my interpretation of the discussion on page 547, Adour et al (1977). This is a little ambiguous. The above score ensures that the maximum score is 100 points.
secondary defect score =
= 10 * (SUM(number of points for secondary defects)
Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score the greater the number of complications present.
Specialty: Neurology, Emergency Medicine, Surgery, general, Otolaryngology
ICD-10: ,
