Pillsbury and Fisch developed the Detailed Evaluation of Facial Symmetry (DEFS) as a system for measuring facial symmetry in patients with injury to the facial nerve. This can be used to supplement other facial nerve functional grading systems.
Photographs are graded for facial symmetry using the following 5 poses:
(1) face at rest
(2) raising the eyebrows and wrinkling the forehead
(3) closure of eyes
(a) with minimal effort and
(b) with maximal effort
(4) smiling
(5) pursing the lips and whistling
|
Symmetry of the Face |
Finding |
Points |
|
face at rest |
total paralysis (0% function) |
0 |
|
|
facial movements closer to total paralysis than normal symmetry (30% function) |
6 |
|
|
facial movements closer to normal symmetry than to total paralysis (70% function) |
14 |
|
|
normal symmetry (100% function) |
20 |
|
wrinkling forehead |
total paralysis (0% function) |
0 |
|
|
facial movements closer to total paralysis than normal symmetry (30% function) |
3 |
|
|
facial movements closer to normal symmetry than to total paralysis (70% function) |
7 |
|
|
normal symmetry (100% function) |
10 |
|
eye closure |
total paralysis (0% function) |
0 |
|
|
facial movements closer to total paralysis than normal symmetry (30% function) |
9 |
|
|
facial movements closer to normal symmetry than to total paralysis (70% function) |
21 |
|
|
normal symmetry (100% function) |
30 |
|
smiling |
total paralysis (0% function) |
0 |
|
|
facial movements closer to total paralysis than normal symmetry (30% function) |
9 |
|
|
facial movements closer to normal symmetry than to total paralysis (70% function) |
21 |
|
|
normal symmetry (100% function) |
30 |
|
whistling |
total paralysis (0% function) |
0 |
|
|
facial movements closer to total paralysis than normal symmetry (30% function) |
3 |
|
|
facial movements closer to normal symmetry than to total paralysis (70% function) |
7 |
|
|
normal symmetry (100% function) |
10 |
DEFS score =
= SUM(points for all 5 poses)
Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score, the more normal the appearance of facial symmetry.
Performance:
• Correlation with global evaluation: 0.98, with excellent agreement in 87% of test cases.
Specialty: Neurology, Emergency Medicine, Surgery, general, Otolaryngology
ICD-10: ,
