Facial Nerve Paralysis Grading System of May

 

Parameters:

(1) muscle tone

(2) wrinkle forehead (tests the highest branch)

(3) close eyes tightly (orbicularis oculi, serves as protective reflex)

(4) blink (orbicularis oculi, aids the lacrimal system)

(5) wrinkle nose (surveys midface)

(6) grin (lower midface)

(7) whistle (lower midface)

(8) blow out cheeks (lower midface)

(9) depress lower lip (mandibular branch)

(10) tense muscles in neck (cervical branch of the facial nerve)

Observation	Points
normal	10
weak	5
absent	0

 

total score =

= SUM(points for all 10 items)

 

Interpretation:

• minimum score: 0

• maximum score: 100

• The higher the score, the better the facial nerve function.

 

Total Score	Other Findings	Shambaugh et al
<= 10		complete palsy
>= 15 and <= 80		incomplete palsy
> 80	no visible synkinesis	complete recovery

 

where:

• The upper limit for incomplete palsy is not given by Shambaugh. I've set it at 80 based on the criteria for recovery.

• The presence of visible synkinesis affects the completeness of recovery. I am using a total score > 80 and visible synkinesis as "incomplete recovery". Incomplete recovery might also be used for a total score below 80 with no visible synkinesis.

• Synkinesis is an involuntary muscle contraction associated with each expression.