Sunnybrook Facial Grading System
Composite facial nerve function score from resting symmetry, voluntary movement, and synkinesis, each graded against the normal side.
Method
Composite = voluntary movement score − resting symmetry score − synkinesis score
- Resting symmetry score = (eye + cheek + mouth) × 5, range 0 to 20.
- Voluntary movement score = sum of the five expressions × 4, range 20 to 100. Each expression is graded 1 (unable to initiate movement), 2 (initiates slight movement), 3 (initiates movement with mild excursion), 4 (movement almost complete), or 5 (movement complete).
- Synkinesis score = sum of the five expressions, range 0 to 15. Each is graded 0 (none), 1 (mild, slight synkinesis), 2 (moderate, obvious but not disfiguring), or 3 (severe, disfiguring synkinesis or gross mass movement of several muscles).
The weights were chosen so that normal facial function scores 100 and complete paralysis scores 0. The system was designed to detect change over time, so it is most useful for tracking a patient before and after treatment. Unlike the House-Brackmann scale, it grades each region separately and has no fixed severity categories.
Source: Ross BG, Fradet G, Nedzelski JM. Development of a sensitive clinical facial grading system. Otolaryngol Head Neck Surg. 1996;114(3):380–386. doi:10.1016/S0194-59989670206-1.
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Grade each item