A Simple, Objective, and Mathematical Grading Scale for the Assessment of Facial Nerve Palsy

Bansal, Mohan; Shah, Alaap; Gosai, Bhavik; Joshi, Krupal; Shah, Pankaj

doi:10.1097/mao.0000000000002450

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…[ 21 ] Main limitations are lack of graphic representations and that it scores only synkinesis among complications. A recent study[ 24 ] proposed a mathematical method that assigns percentages to scored deficits in Facial nerve grading system 2.0.…”

Section: Discussionmentioning

confidence: 99%

Validation of a New Graphic Facial Nerve Grading System

Ojha¹,

Nagendra

Ansari

et al. 2022

Annals of Indian Academy of Neurology

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Background and Objective: Most of the existing qualitative facial nerve grading systems are very subjective while the quantitative grading systems are more complex, require longer data input time and specific software. There is a need for having a scoring system with graphic criteria to improve the subjectivity, reliability and convenience. We aimed to develop and validate such a reliable graphic scale for use in Bell's palsy. Methods: Face videos of patients with unilateral facial paralysis were recorded using smartphones and analyzed for six items including five voluntary facial movements apart from complications of facial palsy (synkinesis, hyperkinesis, and contracture). 15 videos were used for pilot study, 75 for the development of scale and 110 for its validation. Each video was rated on two separate occasions by 3 independent raters, a score of 0-4 was assigned to each item using the graphic scoring criteria, and a composite score was obtained (range 0–24). Five disease severity categories: normal (score 0), mild (score 1–6), moderate (score 7-12), severe (score: 13–18) and profound facial weakness (score: 19-24). Results: The proposed scale and its component items had high inter-rater and intra-rater reliability (Kappa >0.7). Good correlation (Pearson co-efficient >0.7) was seen among the voluntary movements. The proposed scale is a valid tool to score motor deficits and complications of facial palsy. Conclusions: The proposed scale is a valid and reliable graphic scale to describe facial motor dysfunction and its secondary defects.

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Section: Discussionmentioning

confidence: 99%

Validation of a New Graphic Facial Nerve Grading System

Ojha¹,

Nagendra

Ansari

et al. 2022

Annals of Indian Academy of Neurology

View full text Add to dashboard Cite

show abstract

“…Grading systems for evaluating FNP FDI 20 FaCE 21 Psychosocial scale of facial appearance 22 FACE-Q 23 House-Brackmann 3 Sunnybrook 4 Yanagihara facial nerve grading system 24 FNGS 2.0 25 eFACE 26 Glasgow facial palsy scale 27 Facogram 28 The Nottingham system 29 Moiré topography index 30 Computerized facial analyses 7,[31][32][33][34][35][36][37][38][39] Manual measurement of facial points [40][41][42] Abbreviations: FaCE, facial clinimetric evaluation scale; FDI, facial disability index; FNGS, facial nerve grading system; FNP, facial nerve palsy.…”

Section: Patient Experiencementioning

confidence: 99%

Facial nerve palsy: Narrative review on the importance of the eye and its assessment

et al. 2022

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New solutions are emerging that address specific facial regions in facial nerve palsy (FNP). However the most dreaded consequence of FNP is paralytic lagophthalmos threatening the eye. A way to prioritize these regions is thus required. A review of the literature is conduced to capture the current concepts in evaluating FNP. Overall, patients are assessed from three perspectives: from the clinician's perspective using validated clinician‐based grading instruments, from patient's perspective based on FNP‐specific patient‐reported outcome measures, and from the perspective of the layperson. The existing tools however provide limited information regarding the relative importance of different regions of the face. The eye appears to be an area of great concern for the patient where most surgical therapies are directed at. Addressing ocular problems in FNP carry a high priority but this is not clearly reflected by the standard systems.

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Beyond the smile: a systematic review of diagnostic tools for peripheral facial paralysis

Tedeschi,

Donati,

Giorgi

2024

Acta Neurol Belg

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Background Effective rehabilitation of peripheral facial paralysis (PFP) requires reliable assessment tools. This systematic review aimed to identify and validate instruments used in PFP rehabilitation, categorizing them according to the ICF framework. Methods A comprehensive search was conducted across PubMed, Cinahl, Web of Science, and Scopus up to April 2024. Observational analytical studies and one non-randomized controlled trial that validated tools for assessing PFP were included. Results Thirty-three studies were included, covering twenty different tools. Seventeen tools were related to the "Structure and Function" domain, while three addressed "Activity and Participation." The Sunnybrook and House-Brackmann scales were the most extensively studied. The Sunnybrook scale exhibited excellent intra- and inter-rater reproducibility and internal validity, making it suitable for clinical use. The House-Brackmann scale was user-friendly but had limitations in reproducibility and sensitivity to subtle differences, which newer versions like the FNGS 2.0 aimed to address. The FAME scale showed promise by reducing subjective scoring. Computerized tools, such as eFACE and A-FPG, and instruments for lip asymmetry and ocular involvement demonstrated potential but require further validation. The Facial Disability Index and the FaCE Scale were validated for assessing disability and participation restrictions. Conclusion This review identified several validated tools for PFP assessment, with the Sunnybrook and House-Brackmann scales being the most reliable. While emerging tools and computerized programs show promise, they need further validation for routine clinical use. Integrating validated tools into clinical practice is essential for comprehensive assessment and effective rehabilitation of PFP.

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A Simple, Objective, and Mathematical Grading Scale for the Assessment of Facial Nerve Palsy

Cited by 5 publications

References 26 publications

Validation of a New Graphic Facial Nerve Grading System

Validation of a New Graphic Facial Nerve Grading System

Facial nerve palsy: Narrative review on the importance of the eye and its assessment

Beyond the smile: a systematic review of diagnostic tools for peripheral facial paralysis

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