Reliability of the “Sydney,” “Sunnybrook,” and “House Brackmann” Facial Grading Systems to Assess Voluntary Movement and Synkinesis after Facial Nerve Paralysis

Abstract

For clinical grading of voluntary movement, there is good correlation between ratings given on the Sydney and Sunnybrook systems, and within each system there is good reliability. The assessment of synkinesis was far less reliable within, and less related between, systems. Although the reliability of the House Brackmann system was found to be high, examination of individual grades revealed some wide variation between trained observers.

Face-to-Face Versus Video Assessment of Facial Paralysis: Implications for Telemedicine (Preprint)

“…It is a gross scale ranked from 1 to 6, with each grade giving an overall impression of facial function, resting symmetry, and synkinesis [4,5,28,34]. However, the House-Brackmann system is limited in that it does not allow for regional assessment, the range of scores does not reflect clinically important change and lacks sufficient classification of synkinesis [8,26,30,32,[34][35][36]. This has led to the administration of a range of alternative systems being used by practitioners around the world.…”

“…It grades patients in a more objective and continuous manner than the House-Brackmann system, and each component of the system is sensitive to change and contributes to a change in the composite score [1,3,8,26,28,30,32,34,35].…”

“…The Sydney Facial Grading System, which assesses voluntary movement of the five branches of the facial nerve and overall synkinesis, has also been used regionally in Australia [1,6,26] and reported in International Facial Nerve Symposium Conference Proceedings over a 20-year period.…”

“…The mean (SD) age of the 28 patient participants (12 males and 16 females) was 41.7 (15.4) years, with a mean (SD) of 6.5 (6.9) years since FNP onset. There has been no prior research comparing face-to-face and video assessment of FNP so the sample size (n=28) was based on a related study with 21 participants where there was sufficient power to detect differences between the HouseBrackmann, Sydney and Sunnybrook systems [26]. The etiologies of the FNP are presented in Table 1.…”

Avaliação do efeito da toxina botulínica no lado são em pacientes com paralisia facial de longa duração

“…Muitos métodos e escalas foram propostos, com boas revisões para consulta e vários trabalhos comparativos 61,[64][65][66][67][68][69][70] . Sistemas de graduação facial fundamentados em critérios razoáveis têm tendência a se correlacionarem uns com os outros, visto estarem todos orientados às mesmas características na face paralisada 64 .…”