Facial Grading System of Ross et al | Medicalalgorithms.com

Description

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.

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Description

Specialty

ICD-10