Sunnybrook Facial Grading System (SFGS)

Patient selection: evaluation of facial nerve function

 

Measures:

(1) resting symmetry

(2) symmetry of voluntary movements

(3) synkinesis (involuntary muscle contraction)

 

Parameters for resting symmetry:

(1) eye

(2) cheek (naso-labial fold)

(3) mouth

 

Parameter	Finding	Points
eye	normal	0
	narrow	1
	wide	1
	eyelid surgery	1
cheek (naso-labial fold)	normal	0
	absent	2
	less pronounced	1
	more pronounced	1
mouth	normal	0
	corner dropped	1
	corner pulled up or down	1

 

subscore for resting symmetry =

= 5 * SUM(point for all 3 parameters)

 

Parameters for symmetry of voluntary movements:

(1) forehead wrinkle

(2) gentle eye closure

(3) open mouth smile

(4) snarl

(5) lip pucker

 

Muscle Excursion Compared to Normal Side	Degree of Asymmetry	Points for Each Movement
unable to initiate	gross	1
slight movement	severe	2
mild excursion	moderate	3
almost complete	mild	4
complete	none (normal)	5

 

subscore for symmetry of voluntary movements =

= 4 * SUM(points for all 5 movements)

 

Parameters for synkinesis:

(1) forehead wrinkle

(2) gentle eye closure

(3) open mouth smile

(4) snarl

(5) lip pucker

 

Synkinesis	Points for Each Movement
none	0
mild	1
moderate	2
severe	3

 

subscore for synkinesis =

= SUM(points for all 5 movements)

 

composite score =

= SUM(all 3 subscores)

 

Interpretation:

• minimum subscore for resting symmetry: 0

• maximum subscore for resting symmetry: 20

• minimum subscore for voluntary movement: 20

• maximum subscore for voluntary movement: 100

• minimum subscore for synkinesis; 0

• maximum subscore for synkinesis: 15

• minimum composite score: -15

• maximum composite score: 100

• The lower the score the greater the facial nerve dysfunction.