COSMIN database

Facial nerve grading instruments: systematic review of the literature and suggestion for uniformity

Fattah, A. Y., Gurusinghe, A. D., Gavilan, J., Hadlock, T. A., Marcus, J. R., Marres, H., Nduka, C. C., Slattery, W. H., Snyder-Warwick, A. K., and Sir Charles Bell, Society
BACKGROUND: A variety of facial nerve grading scales have been developed over the years with the intended goals of objectively documenting facial nerve function,tracking recovery, and facilitating communication between practitioners. Numerous scales have been proposed; however, all are subject to limitation because of varying degrees of subjectivity, reliability, or longitudinal applicability. At present, such scales remain the only widely accessible modalities for facial functional assessment. The authors' objective was to ascertain which scales(s) best accomplish the goals of objective assessment.

METHODS: A systematic review of the English language literature was performed to identify facial nerve grading instruments. Each system was evaluated against the following criteria: convenience of clinical use, regional scoring, static and dynamic measures, features secondary to facial palsy (e.g., synkinesis), reproducibility with low interobserver and intraobserver variability, and sensitivity to changes over time and/or following interventions.

RESULTS: From 666 articles, 19 facial nerve grading scales were identified. Only the Sunnybrook Facial Grading Scale satisfied all criteria. The Facial Nerve Grading Scale 2.0 (or revised House-Brackmann Scale) fulfilled all criteria except intraobserver reliability, which has not been assessed.

CONCLUSIONS: Facial nerve grading scales intend to provide objectivity and uniformity of reporting to otherwise subjective analysis. The Facial Nerve Grading Scale 2.0 requires further evaluation for intraobserver reliability. The Sunnybrook Facial Grading Scale has been robustly evaluated with respect to the criteria prescribed in this article. Although sophisticated technology-based methodologies are being developed for potential clinical application,the authors recommend widespread adoption of the Sunnybrook Facial Grading Scale as the current standard in reporting outcomes of facial nerve disorders.
Plast Reconstr Surg
1529-4242 (Electronic)
Publication year:
Symptom status:
Physical state
Functional status:
Physical functioning
Diseases of and symptoms related to the nervous system
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
6 - Clinical rating scales
7 - Observations
Adour-Swanson facial nerve grading system
DEFS - Detailed Evaluation of Facial Symmetry
FEMA grading system
FGS - Toronto/Sunnybrook Facial Grading System
FNGS2.0 - Facial Nerve Grading Scale 2.0
Grading system of Saito
House-Brackmann Scale
Linear Measurement Index
Manktelow's method
May facial nerve grading system
MoReSS facial nerve grading scale
Nottingham System
Rough Grading Scale
Scales of Botman and Jongkees
Scales of Janssen
Scales of Peitersen
Scales of Smith et al.
Sydney facial grading system
Yanagihara facial nerve grading system